Attachment A Modified Proposal Signature Page.doc
DOC document 42 KB Posted
- Attached to
- KATA-8710 RFP SOLICITATION
- Solicitation number
- RFP KATA 2016000249 4
- Issued by
- Colorado
About this file
This is a proposal signature page for a Request for Proposals (RFP) issued by the Colorado Department of Labor and Employment (CDLE) for Petroleum Storage Tank Assessment, Remediation and Emergency Response services. The RFP number is KAA 2016000249-P, with proposals due on June 28, 2016, at 11:00 a.m. Mountain Time. The document requires vendors to provide comprehensive business information including tax identification numbers, contact details, and authorized signatures in ink from a company representative with authority to bind the organization.
The form includes mandatory self-certification sections for tracking participation by minority-owned, women-owned, and small business enterprises (M/WBEs) doing business with the State of Colorado. Vendors must identify gender and ethnicity ownership information and indicate whether they qualify as small businesses with 25 or fewer full-time equivalent employees. Additionally, vendors must specify payment terms, with the requirement that proposed terms be at least 30 days. For vendors owned or controlled by parent companies, the parent company's tax identification number and main office address must be provided, as the parent company will be held legally responsible for contract performance. This signature page must be submitted in the original proposal only and constitute an integral part of all vendor responses.
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Text version
Modified Attachment A
Colorado Department of Labor and Employment (CDLE)
RFP KATA-2016000249-P
Proposal Signature Page
RFP Number:
KAA 2016000249-P – Petroleum Storage Tank Assessment, Remediation and Emergency Response Due Date:
June 28, 2016, 11:00 a.m., Mountain Time
(Please print or type information)
Vendor’s Tax ID Number (FEIN)* ___________________________________________
Vendor _________________________________________________________________
Vendor Contact Name _____________________________________________________
Vendor Address __________________________________________________________
Vendor’s Telephone _______________________________________________________
Vendor’s Fax ____________________________________________________________
Vendor’s E-mail __________________________________________________________
Minority and Women-owned Business (M/WBEs) or Small Business Enterprise Self Certification:
In an effort to track levels of participation by women, minorities, and small business enterprises doing business with the State of Colorado, the following information is requested. Please indicate the appropriate category of ownership for your company. “Owned” in this context means a business that is at least 51 percent owned by an individual(s) who also control(s) and operate(s) the business. “Control” in this context means exercising the power to make policy decisions. “Operate” means actively involved in the day-to-day management. If your business is jointly owned by both men and women or is a large publicly held corporation, please check the box labeled “Not Applicable.”
Gender Information:
□ Female-Owned □ Male-Owned □ Not Applicable
Owner Ethnicity Information:
□ African American □ Asian/Pacific American □ White (non-Hispanic) □ Not Applicable
□ Hispanic American □ Native American □ Other: _____________________________
Small Business Information:
Small Business (a business that is organized for profit, is independently owned and operated, and has 25 or fewer full time equivalent employees.)
□ Yes □ No
RFP Number:
KAA 2016000249-P – Petroleum Storage Tank Assessment, Remediation and Emergency Response Due Date:
June 28, 2016, 11:00 a.m., Mountain Time
(Please print or type information)
Handwritten Signature by authorized officer or agent of vendor – MUST BE SIGNED IN INK
Typed or printed name of authorized officer or agent of vendor
Title of authorized officer or agent of vendor
Payment Terms __________________________________________
(Terms of less than 30 days will not be considered)
*PARENT COMPANY. A vendor, owned or controlled by a parent company, must provide the name, main office address and parent company’s tax identification number on a copy of this form. The tax identification number provided must be that of the vendor’s parent company who will be legally responsible for performing services under the contract resulting from this Request for Proposals.
THIS FORM MUST ACCOMPANY ALL PROPOSALS (IN ORIGINAL PROPOSAL ONLY). AN AUTHORIZED OFFICER OR AGENT OF THE VENDOR MUST SIGN THE PROPOSAL IN INK.
RETURN THESE TWO PAGES IN ORIGINAL RESPONSE ONLY
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