SourceDisclosureCertification.pdf

PDF 95 KB Posted Nov 22, 2016

Attached to: T0125 Tower Maintenance
Solicitation number: 17DPP00077
Issued by: Burlington County, New Jersey

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Written by GovTribe AI · Apr 3, 2024

This document is a Source Disclosure Certification form for a solicitation issued by the Division of Purchase and Property, Department of the Treasury, State of New Jersey. The form requires the contractor to list every location where services will be performed, including any services that cannot be performed within the United States, and provide justification for why those services cannot be performed in the U.S. The contractor must certify that the information provided is true and complete, and acknowledge that providing false statements could result in criminal prosecution and breach of contract.

The related state and local contract opportunity is for T0125 Tower Maintenance, which involves Mercer County, New Jersey. The contract details, such as quantities, response dates, and term, are not provided in the given information.

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Other files

File	Type	Posted
17DPP00077 T0125 Tower Maintenance Bid Solicitation.docx	DOCX document	Nov 22, 2016
CooperativePurchasingForm.pdf	PDF	Nov 22, 2016
SubcontractorUtilizationPlan~1.pdf	PDF	Nov 22, 2016
Vendor Checklist T0125.pdf	PDF	Nov 22, 2016
ATTACHMENT 1 RESUMES T0125 Tower Maintenance.docx	DOCX document	Nov 22, 2016
Offer and Acceptance Page- T0125.pdf	PDF	Nov 22, 2016
Price Schedule T0125 Tower Maintenance.xlsx	XLSX spreadsheet	Nov 22, 2016
ATTACHMENT 2 Questionnaire T0125 Tower Maintenance.docx	DOCX document	Nov 22, 2016

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STATE OF NEW JERSEY—DIVISION OF PURCHASE AND PROPERTY

SOURCE DISCLOSURE FORM

Solicitation Number: _______________________ Bidder/Offeror: ______________________________________

The Contractor submits this Certification in response to the solicitation issued by the Division of Purchase and Property, Department of the Treasury, State of New Jersey ("Division"), in accordance with the requirements of N.J.S.A. 52:34-13.2.

Instructions:

List every location where services will be performed by the Contractor and all Subcontractors.

If any of the services cannot be performed within the United States, the Contractor shall state, with specificity, the reasons why the services cannot be performed in the United States.

The Contractor shall provide justification that the services cannot be performed in the United States by a contractor. The Director will review this justification and if deemed sufficient, the Director may seek the Treasurer’s approval.

Any changes to the information set forth in this Certification during the term of any contract awarded under the referenced solicitation or extension thereof will be immediately reported by the Vendor to the Director, Division of Purchase and Property (the "Director").

I understand that, after award of a contract to the Contractor, it is determined that the Contractor has shifted services declared above to be provided within the United States to sources outside the United States, prior to a written determination by the Director that circumstances require the shift of services or that the failure to shift the services would result in economic hardship to the State of New Jersey, the Contractor shall be deemed in breach of contract, which contract will be subject to termination for cause pursuant to the State of New Jersey Standard Terms and Conditions.

I further understand that this Certification is submitted on behalf of the Contractor in order to induce the Division to accept a proposal, with knowledge that the Division is relying upon the truth of the statements contained herein.

Certification: I, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I am authorized to execute this certification on behalf of the bidder; that the State of New Jersey is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the completion of any contracts with the State to notify the State in writing of any changes to the information contained herein; that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I am subject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the State, permitting the State to declare any contract(s) resulting from this certification void and unenforceable.

Full Name (Print): ___________________________________________ Signature: __________________________________________________

Title: ______________________________________________________ Date: ______________________________________________________

Contractor/ Subcontractor Name

Performance Location by Country

Description of Services Reason Services Cannot Be Performed in U.S.

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File details come from the government source that posted it. Updated Apr 3, 2024.