OMESformCP076.pdf
PDF 181 KB Posted
- Attached to
- Oklahoma Local Ag Summit - 2027
- Solicitation number
- EV00000902
- Issued by
- Oklahoma County, Oklahoma
About this file
This is an OMES Form CP076 Responding Bidder Information form used by the State of Oklahoma's Central Purchasing division for solicitation EV00000902 related to the Oklahoma Local Ag Summit - 2027. The form serves as a certification document that bidders must submit along with their response to the solicitation. The project involves facility rental and food services for a conference. The form requires bidders to provide general information including FEIN/SSN, Supplier ID, company name, contact details, address, website, and fax number, along with the authorized signature, date, and title of the person submitting the response.
The form includes several compliance certifications that bidders must address. Bidders must declare whether they are engaged in a boycott of goods or services from Israel, confirm registration status with the Oklahoma Secretary of State (or provide an exemption statement), and provide proof of workers' compensation insurance coverage or documentation of exempt status under Oklahoma Administrative Code. The form also requires certification if the bidder qualifies as a service-disabled veteran business enterprise, with supporting documentation including verification of service-disabled veteran status, proof of at least 51% ownership by service-disabled veterans, and evidence of management control by service-disabled veterans. All sections of the form must be completed and signed by an authorized representative prior to contract award.
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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: EV00000902 |
| 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 .