OMESFormCP076.pdf
PDF 167 KB Posted
- Attached to
- Newborn Metabolic Screening Filter Paper Kits
- Solicitation number
- EV00000653
- Issued by
- Ottawa County, Tamaha Town, Oklahoma
About this file
This is a Responding Bidder Information form (OMES FORM CP 076) from the Oklahoma Office of Management & Enterprise Services (OMES). The form is required to be submitted along with the "Certification for Competitive Bid and Contract" as part of a response to a solicitation. The form collects essential bidder information including general company details, contact information, federal employer identification (FEI) number, and supplier ID.
The form requires bidders to declare whether they are engaged in a boycott of goods/services from Israel, verify registration with the Oklahoma Secretary of State (required for contracts over $250,000), provide proof of Workers' Compensation Insurance coverage, and indicate if they qualify as a service-disabled veteran business under the Disabled Veteran Business Enterprise Act. Service-disabled veteran businesses must provide federal certification of status, verification of at least 51% ownership by service-disabled veterans, and confirmation of management control by service-disabled veterans.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit_1_-_Collection_Kit_Example.pdf | ||
| AttachmentB-NegotiableTerms.docx | DOCX document | |
| Attachment_G_Federal_Funding_Terms.pdf | ||
| Attachment_A-NonNegotiable.pdf | ||
| Exhibit_3_-_Specifications.pdf | ||
| BID_PACKET_ATTACHMENTS_INSTRUCTIONS.pdf | ||
| OMESFormCP004.pdf | ||
| Agency_Bid_Instructions.pdf | ||
| Exhibit_2-Cost.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: (if over $250,000)
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 http://www.sos.ok.gov/ 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 .