OMESFormCP076_(8).docx
DOCX document 68 KB Posted
- Attached to
- Sallisaw Plumbing Replacement
- Solicitation number
- EV00000888
- Issued by
- Sequoyah County, Oklahoma
About this file
This is a Certification for Competitive Bid and Contract form (OMES Form CP 076) required by the State of Oklahoma for submission with bid responses to Solicitation #EV00000888. The form is associated with a plumbing replacement project at the Sallisaw Office located at 629 N Harriet, Sallisaw, Oklahoma 74955. Bidders must complete and submit this certification form along with their formal bid response. The document requires bidders to provide general company information including Federal Employer Identification Number or Social Security Number, Supplier ID, company name, and detailed contact information for the primary representative.
The certification form establishes several compliance and eligibility requirements that bidders must address prior to contract award. Bidders must declare their current boycott status regarding Israeli goods or services, confirm registration status with the Oklahoma Secretary of State, and provide proof of Workers' Compensation Insurance coverage or submit a signed exemption statement if applicable under Oklahoma law. Additionally, bidders may self-identify as service-disabled veteran businesses and, if claiming this status, must include appropriate federal certification and documentation proving at least 51 percent ownership and management control by one or more service-disabled veterans. An authorized representative must sign and date the completed form with printed name and title.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Bidder_Instructions_(3).docx | DOCX document | |
| Attachment_B_State_General_Terms.pdf | ||
| SolicitationContractAttachmentA_(6).docx | DOCX document | |
| OMESFormCP021_(6).docx | DOCX document | |
| Exhibit_1_(1).docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Responding Bidder Information
“Certification for Competitive Bid and Contract” MUST be submitted along with the response to the Solicitation.
1. RE: Solicitation # EV00000888
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
OMES FORM CP 076 Rev. 11/2020
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 image1.jpeg
File details come from the government source that posted it. Updated .