Waitless Exhibits DRAFT Revision1.pdf

Contract Routing # TAA 15/

EXHIBIT A – STATEMENT OF WORK

To be modified upon award

THE REST OF THIS PAGE INTENTIONALLY LEFT BLANK

EXHIBIT B – PRICES AND RATES

EXHIBIT C – CONTRACTOR’S PROPOSAL

EXHIBIT D – OPTION LETTER

Date: Original Contract CMS #:

Option Letter #

CMS Routing #

1) Option to renew only (for an additional term)

a. In accordance with Section(s) 5Cof the Original Contract between the State of Colorado, Department of

Revenue, Division of Motor Vehicles, and Marquis ID Systems, the State hereby exercises its option for an additional term beginning Insert start date and ending on Insert ending date at a cost/price specified in Section 7 and Exhibit B, AND/OR an increase/decrease in the amount of goods/services at the same rate(s) as specified in 7 and Exhibit B.

b. The amount of the current Fiscal Year contract value is increased/decreased by $ amount of change to a new contract value of Insert New $ Amt to as consideration for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year. The first sentence in Section is hereby modified accordingly. The total contract value including all previous amendments, option letters, etc. is Insert New $ Amt.

2) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or , whichever is later.

APPROVALS:

State of Colorado:

John W. Hickenlooper, Governor

By: _____________________ Date: __________________ For the Executive Director Colorado Department of Revenue

ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER

CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for goods and/or services provided.

State Controller Robert Jaros, CPA, MBA, JD

By: _____________________

Date: ____________________

Option Letter can now be used to renew for an additional term, change the amount of goods/services within the current term, or change in amount of goods/services in conjunction with renewal for additional term.

EXHIBIT E – STATEMENT OF CONFIDENTIALITY

STATE OF COLORADO

DEPARTMENT OF REVENUE

DIVISION OF MOTOR VEHICLE

As an employee, officer, staff member, temporary employee or subcontractor of _________________________, you may have access to State of Colorado, Department of Revenue, Division of Motor Vehicles (“State”) official motor vehicle and/or driver records. The confidentiality of the information contained within these Records shall be maintained at all times. Record information shall not be distributed, sold or shared with any third party nor used by you in any way except as expressly authorized by the State. Disclosure of such information may be cause for legal action against you, the Vendor and any involved third party. The State shall not be in any way responsible for defense of any such action.

Pursuant to C.R.S. 42-1-206, any person who willfully and knowingly obtains, resells, transfers, or uses information in violation of law shall be liable to any injured party for treble damages, reasonable attorneys’ fees, and costs. Other civil and criminal laws may also apply.

I hereby acknowledge that I am and shall remain in compliance with all State and Federal laws and the contractual terms and conditions between the Vendor and the State pertaining to the security and confidentiality of motor vehicle and driver records.

Signature Date

Print Name

Title

Company Name

EXHIBIT F – AFFIDAVIT OF NON-CONFLICT OF INTEREST

As an employee, officer, staff member or sub-contractor of ____________________________, I hereby certify that I will perform and conduct consulting services under the guidelines, procedures, policies and requirements of the State of Colorado or the Department of Revenue, Division of Motor Vehicles and the contract/purchase order as a fair and impartial participant.

I hereby certify that I have no conflicts of interest. Further, I represent as follows:

1. I promise to conduct the services in an independent, impartial and responsive manner.

2. I will disclose the nature and extent of any financial interests (direct or indirect) to the State for its evaluation of the significance of the financial interest on participation in this contract/purchase order.

Except as I shall disclose in detail, I neither have nor shall I during consulting services contract, including any extensions, acquire any financial interest that would conflict in any manner or degree with my contract responsibilities.

3. As an employee of the Contractor and/or its subcontractors, I shall be prohibited from separately bidding for any goods or services required by this Contract.

4. As an employee of the Contractor and/or its subcontractors, I shall be responsible for disclosing to the State receipt of any communication asserting any conflict of interest.

5. I agree to resign any accounts if the State, within its sole discretion, determines that such accounts are in conflict with the best interests of the State. Examples of such conflicts would be accounts that become matters of public controversy that could reflect negatively on the State.

If I should become aware of any situation that may arise, that could alter any of the representations above, or that might otherwise create the appearance of a conflict or other impropriety, I shall notify the State immediately.

Signature Date Print Name Title

EXHIBIT G – NON DISCLOSURE AND CONFIDENTIALITY AGREEMENT

STATE OF COLORADO

NON DISCLOSURE AND

CONFIDENTIALITY AGREEMENT

I, ________________________________, understand that in the course of my employment or contract with the State of Colorado, its offices, agencies and/or departments either by direct contract or through agreements between State offices, agencies or departments I may receive or become aware of business or personnel information that is sensitive and/or confidential and not available to the general public.

This information may be written, electronic, or verbal and come from a variety of sources. I understand that this information may be subject to special protections under State or Federal laws or polices of the State office, agency or department. I understand that I am not to intentionally access sensitive or confidential information unless it is necessary in order for me to complete my job responsibilities and if so, such necessity will be set out in a statement of work regarding the specific project I am working on.

I acknowledge that I have an affirmative responsibility to protect all sensitive or confidential information I become aware of during the course of my duties. I further understand that this obligation does not apply to information I may become aware of that is available to the general public, through common knowledge or internet search.

I understand that in the performance of my duties I may be requested to provide sensitive or confidential information to others. I agree to hold in confidence and to not disclose any sensitive or confidential information to any person, including employees of state, federal or local governments including law enforcement, except to those who have an official business reason for the information. Should I have any questions regarding the proper handling or disclosure of confidential or sensitive information, I will immediately notify my supervisor or manager and/or the supervisor or manager of the project I am working on for further clarification and direction prior to releasing any information.

If I willfully and knowingly disclose such information in any manner to any person or agency not entitled to receive the information, I understand that I may be subject to adverse action, including corrective or disciplinary action, dismissal or personal liability depending on the severity of my actions and applicable law. It is my duty and responsibility to return all State information and not to retain any copies, in any format upon the completion of my employment or contract.

I acknowledge that I have read, understand, and will adhere to the above requirements with respect to sensitive and/or confidential information.

Signature _____________________________

Printed Name _____________________________

Date Signed _____________________________

Original to be maintained at the office of the State Chief Information Security Officer and is available for review upon request.