Attachment 1 Vendor Information-Confirmation of Offer Form UPDATED.docx
DOCX document 148 KB Posted
- Attached to
- Produce Prescription Program
- Solicitation number
- RFP FAAA 2026000284 1
- Issued by
- Arapahoe County, Denver City, Colorado
About this file
This is a Vendor Information and Confirmation of Offer Form for the State of Colorado's solicitation number 2026000284 regarding the Expansion of Produce Prescription Program. The form serves as the official submission document for vendors responding to this opportunity and must be completed with accurate vendor information including the Colorado Vendor Customer Number, Federal Employer Identification Number (FEIN), Unique Entity Identifier (UEI), legal name, and authorized signatory details. Vendors are required to confirm their understanding that responses are subject to all conditions and specifications outlined in the solicitation and must verify that all work will be performed within the state of Colorado. The form requires submission of a signed original as part of the complete solicitation response package.
The form emphasizes that the FEIN and Vendor Customer Number provided must match the Colorado VSS (Vendor Self-Service) registration to establish eligibility for award, and these identifiers will be used for all subsequent contracting, issuance of award, and payment processes. Vendors must designate an authorized signatory and provide a point of contact for solicitation-related communications, including contact information and email address. All offerors are instructed to thoroughly review the complete solicitation document prior to submission to ensure compliance with all requirements and accurate representation of vendor credentials.
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Text version
Attachment 1
SOLICITATION NO: 2026000284
TITLE: Expansion of Produce Prescription Program
Vendor Information & Confirmation of Offer Form
Responses submitted are subject to the conditions stipulated in the solicitation and the specifications set forth in the solicitation.
PLEASE TYPE OR PRINT INFORMATION
VENDOR CUSTOMER # (From Colorado VSS):___________________________________________________________________
FEDERAL EMPLOYER’S IDENTIFICATION (FEIN) #: _______________________________________________________________
UNIQUE ENTITY IDENTIFIER (UEI #) (if applicable): ______________________________________________________________
LEGAL NAME of OFFEROR: __________________________________________________________________________________
DBA (if applicable):_______________________________________________________________________________________
ADDRESS: ______________________________________________________________________________________________
CITY, STATE, ZIP: _______________________________________________________________________________________
NAME OF AUTHORIZED SIGNATORY: ________________________________________________________________________
TITLE OF AUTHORIZED SIGNATORY: ________________________________________________________________________
E-MAIL ADDRESS: ______________________________________________________________________________________
PHONE #: __________________________________________
The signature below signifies my review and approval of this solicitation response.
___________________________________________________________________ DATE: ___________________________ Original (in ink) or Digital Signature of Authorized Signatory
POINT OF CONTACT FOR SOLICITATION-RELATED COMMUNICATIONS:
NAME______________________________________________ PHONE #: ______________________________________
TITLE: _____________________________________________
E-MAIL: _____________________________________________________________________________________________
Offerors are urged to read the solicitation document thoroughly before submitting a response. The Vendor Customer Number and F.E.I.N. referenced above will be used for issuance of award, contracting, and payment for the winning response. Verify that the provided numbers are correct for the entity submitting this response. The FEIN must match VSS registration to be eligible for award.
Vendor anticipates that all work be performed within the state of Colorado: ☐ Yes ☐ No
SUBMIT SIGNED ORIGINAL OF THIS FORM WITH ORIGINAL SOLICITATION RESPONSE
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File details come from the government source that posted it. Updated .