OMESFormCP076_(002).pdf
PDF 187 KB Posted
- Attached to
- FY25 Bath_Facial Tis_Papr Twl
- Solicitation number
- EV00000564
- Issued by
- Cleveland County, Oklahoma City, Oklahoma
About this file
This document is an OMES FORM CP 076, which is a "Certification for Competitive Bid and Contract" required to be submitted along with a response to a solicitation by the State of Oklahoma.
The document requests general information about the bidder, including their Federal Employer Identification Number or Social Security Number, Supplier ID, company name, contact details, and whether the bidder is currently engaged in a boycott of goods or services from Israel. It also requires the bidder to register with the Oklahoma Secretary of State or provide details supporting an exemption, as well as provide a certificate of insurance showing proof of compliance with the Oklahoma Workers' Compensation Act or a written statement claiming exemption. The document further asks if the bidder qualifies as a service-disabled veteran business enterprise, and requires supporting documentation if so.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| AttachmentB-NegotiableTerms_(2).pdf | ||
| OMESFormCP004_(002).pdf | ||
| Scope_of_Work.pdf |
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Text version
OMES FORM CP 076 Rev. 11/2020 PAGE 1 OF 2
Responding Bidder Information
“Certification for Competitive Bid and Contract” MUST be submitted along with the response to the Solicitation.
1. RE: Solicitation #
2. Bidder General Information:
FEI / SSN : Supplier ID:
Company Name:
3. Bidder Contact Information:
Address:
City: State: Zip Code:
Contact Name:
Contact Title:
Phone #: Fax #:
Email: Website:
4. Bidder currently engaged in a 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 will be 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 (www.sos.ok.gov or 405-521-3911).
6. Workers’ Compensation Insurance Coverage:
Bidder is required to provide with the bid a certificate of insurance showing proof of compliance with the Oklahoma Workers’ Compensation Act.
YES – Include with the bid a certificate of insurance.
NO – Exempt from the 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.1
1 For frequently asked questions concerning workers’ compensation insurance, see https://www.ok.gov/wcc/Insurance/index.html
EV00000564
OMES FORM CP 076 Rev. 11/2020 PAGE 2 OF 2
7. Disabled Veteran Business Enterprise Act
YES – I am a service-disabled veteran business as defined in 74 O.S. §85.44E. Include with the bid response 1) certification of service-disabled veteran status as verified by the appropriate federal agency, and 2) verification of not less than 51% ownership by one or more service-disabled veterans, and 3) verification of the control of the management and daily business operations by one or more service-disabled veterans.
NO – Do not meet the criteria as a service-disabled veteran business.
Authorized Signature Date
Printed Name Title
File details come from the government source that posted it. Updated .