OMESFormCP076.pdf
PDF 166 KB Posted
- Attached to
- FY25 Clinton Veterans Home Console Heat Pumps
- Solicitation number
- EV00000551
- Issued by
- Creek County, Oklahoma
About this file
This document is the OMES FORM CP 076 "Certification for Competitive Bid and Contract" that must be submitted along with a response to a solicitation. The form collects information about the responding bidder, including their Federal Employer Identification Number or Social Security Number, Supplier ID, company name, contact information, and whether the bidder is currently engaged in a boycott of goods or services from Israel. The form also requires the bidder to indicate if they are registered with the Oklahoma Secretary of State, provide proof of workers' compensation insurance coverage, and certify if they qualify as a service-disabled veteran business enterprise.
The form does not provide details about the specific products or services being procured, project overviews, quantities, response and due dates, site visits, bidder's conferences, award dates, or contract term and renewal options. It also does not include information about pricing terms, set asides, incumbents, funding requirements or sources, or other salient details about the procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| OMESFormCP004.pdf | ||
| Attachment_A_-_Scope_of_Work_Clinton_Console_Heat_Pumps.pdf | ||
| StateGeneralTerms.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
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 .