OMES_Form_CP076-Responding_Bidder_Information.pdf

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Attached to
SW1025- It Staff Services
Solicitation number
EV00000685
Issued by
Oklahoma

About this file

This document is an OMES (Oklahoma Management & Enterprise Services) Central Purchasing Responding Bidder Information form designed for potential vendors participating in a state procurement process. The form requires bidders to provide comprehensive company and contact information, and attest to several key compliance requirements specific to Oklahoma state contracting.

The form includes mandatory certifications regarding workers' compensation insurance, potential boycotts of Israeli goods/services, Oklahoma Secretary of State registration, and service-disabled veteran business enterprise status. Bidders must provide details such as company identification, contact information, and verification of compliance with state regulations. Key requirements include providing proof of workers' compensation insurance, confirming state business registration, and, if applicable, documenting service-disabled veteran business credentials. The form serves as a standardized method for vendors to self-certify their eligibility and provide essential information for participation in Oklahoma state contract opportunities.

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OMES Form CP076 (11/2024) RESPONDING BIDDER INFORMATION | Page 1 of 1

Central Purchasing

RESPONDING BIDDER INFORMATION

You must submit a Certification for Competitive Bid and Contract along with the response to the solicitation.

1. SOLICITATION

Solicitation #

2. BIDDER GENERAL INFORMATION

FEIN/SSN Supplier ID

Company name

3. BIDDER CONTACT INFORMATION

Address

Contact name Title

Email Phone Website Fax

4. BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL

Yes No

5. REGISTRATION WITH THE OKLAHOMA SECRETARY OF STATE

Yes Filing number:

No Prior to the contract award, the successful bidder is required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming (sos.ok.gov or 405- 521-3911).

6. WORKERS’ COMPENSATION INSURANCE COVERAGE

Bidder is required to provide a certificate of insurance showing proof of compliance with the Oklahoma Administrative Workers’ Compensation Act.

Yes Include a certificate of insurance with the bid.

No Exempt from the Administrative Workers’ Compensation Act pursuant to 85A O.S. § 2(18)(b)(1-11). (Attach a written, signed and dated statement on letterhead stating the reason for the exempt status. For frequently asked questions concerning workers’ compensation insurance, visit wcc.ok.gov.)

7. DISABLED VETERAN BUSINESS ENTERPRISE ACT

Yes I am a service-disabled veteran business as defined in 74 O.S. § 85.44E.

Include the following with the bid response:

1. Certification of service-disabled veteran status as verified by the appropriate federal agency.

2. Verification of not less than 51% ownership by one or more service-disabled veterans.

3. Verification of the control of the management and daily business operations by one or more service-disabled veterans.

No I do not meet the criteria as a service-disabled veteran business.

8. SIGNATURE

Authorized signature Date

Name Title

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