OMESformCP076.pdf
PDF 286 KB Posted
- Attached to
- EDE-first State Based Exchange
- Solicitation number
- EV00000956
- Issued by
- Oklahoma
About this file
This is a Responding Bidder Information form (OMES Form CP076) issued by the State of Oklahoma's Central Purchasing office for use in state and local contract solicitations. The form serves as a certification document that bidders must complete and submit alongside their response to a solicitation. The form collects essential bidder identification information, including FEIN/SSN, Supplier ID, company name, contact information, and website details. Bidders must provide their authorized signature and date to validate their submission, along with the relevant solicitation number to ensure proper tracking and matching with the corresponding competitive bid opportunity.
The form includes several certification and compliance requirements that bidders must address. These include declarations regarding Israel boycotts, registration status with the Oklahoma Secretary of State, workers' compensation insurance coverage in compliance with the Oklahoma Administrative Workers' Compensation Act, and eligibility status under the Disabled Veteran Business Enterprise Act. Bidders claiming exemptions from workers' compensation requirements or disabled veteran business status must provide supporting documentation with their bid response, including certificates of insurance, certification of service-disabled veteran status from federal agencies, verification of ownership percentages, and documentation of management control. The form emphasizes that successful contract awardees must complete Secretary of State registration prior to contract award unless a signed exemption statement is provided.
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Text version
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 https://www.sos.ok.gov/ https://www.wcc.ok.gov/
| Central Purchasing |
| RESPONDING BIDDER INFORMATION |
| Solicitation: |
| FEINSSN: |
| Supplier ID: |
| Company name: |
| Contact name: |
| Title: |
| Email: |
| Phone: |
| Website: |
| Fax: |
| 4 BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL: Off |
| Prior to the contract award the successful bidder is required to register with the Secretary of State or must attach a: Off |
| Compensation Act: Off |
| 7 DISABLED VETERAN BUSINESS ENTERPRISE ACT: Off |
| Date: |
| Name: |
| Title_2: |
| Filing number: |
| Address: |
File details come from the government source that posted it. Updated .