OMESformCP076.pdf
PDF 286 KB Posted
- Attached to
- Braille devices for the AIM Center
- Solicitation number
- EV00000982
- Issued by
- Oklahoma
About this file
This is an OMES Form CP076 Responding Bidder Information form used by Oklahoma's Central Purchasing division for state and local contract solicitations. The form pertains to a procurement opportunity for Braille devices for the AIM Center, specifically requesting 2 Monarch braille devices or equivalent units. The document serves as the certification and bidder information submission required alongside competitive bid responses to state and local solicitations in Oklahoma.
The form requires bidders to provide comprehensive information including FEIN/SSN, Supplier ID, company name, contact details, and website information. Bidders must certify their status regarding several statutory requirements: whether they are engaged in boycotts of Israeli goods or services, registration status with the Oklahoma Secretary of State (with filing number documentation), workers' compensation insurance coverage compliance under the Oklahoma Administrative Workers' Compensation Act, and qualification as a service-disabled veteran business enterprise under 74 O.S. § 85.44E. For workers' compensation exemptions, bidders must provide written, signed, and dated statements on company letterhead detailing their exemption basis. Service-disabled veteran business applicants must include federal certification of veteran status, verification of at least 51 percent ownership by service-disabled veterans, and documentation of management control by service-disabled veterans. All submissions require authorized signature, date, name, and title of the signing officer.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| attachment-b-general-terms.docx | DOCX document | |
| Price_Exhibit_1.xlsx | XLSX spreadsheet | |
| attachment-d-it-terms.docx | DOCX document | |
| Specifications.docx | DOCX document | |
| Bid_instructions.docx | DOCX document | |
| omes-form-cp004.docx | DOCX document |
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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 .