Exhibit A Vendor_Info_and_Confirmation_of_OfferSL___6450.pdf
PDF 72 KB Posted
- Attached to
- Lake County Lead Contamination Remediation
- Solicitation number
- RFQ FAAA 2017000027 2
- Issued by
- Kit Carson County, Denver City, Colorado
About this file
This is a Vendor Information Form and Confirmation of Offer issued by the Colorado Department of Public Health and Environment, Hazardous Materials and Waste Management Division, for solicitation RFQ FAAA 2017000027 regarding Lead Remediation Services. The form serves as the required submission document for vendors responding to the hazardous materials and waste management solicitation. Responses must be submitted to the Colorado Department of Public Health and Environment Contracts and Purchasing Unit Mail Room at 4300 Cherry Creek Drive South, Denver, Colorado 80246-1530, attention Allan Smith, Purchasing Agent. All solicitation responses and this form must be clearly marked with the solicitation number, due date, and time on the outside of the submittal package.
The form requires vendors to provide complete company information including Federal Employer's Identification Number, VSS Registration Number, company name, DBA if applicable, full address, typed or printed name of authorized representative, and handwritten signature of an authorized company officer or agent. Additional required information includes the signing officer's title, signature date, email address, phone number, fax number, and the name, phone number, and email address of the point of contact for solicitation-related communications. Interested vendors should direct telephone inquiries regarding the solicitation to Allan Smith at (303) 692-2072. A signed original of this form must be submitted with the original solicitation response.
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Text version
Exhibit A
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
Vendor Information Form / Confirmation of Offer
SOLICITATION #: (RFQ) FAAA 2017000027
HAZARDOUS MATERIALS AND WASTE MANAGEMENT DIVISION
REMEDIAL PROGRAMS
LEAD REMEDIATION SERVICES
Responses must be clearly marked with SOLICITATION #, DUE DATE and TIME on the outside of the submittal.
Responses submitted subject to the conditions stipulated herein and in accordance with the specifications set forth in the solicitation will be accepted at the address listed below prior to the submittal deadline.
RETURN SOLICITATION RESPONSE AND THIS FORM TO:
Colorado Department of Public Health & Environment Contracts and Purchasing Unit
Mail Room (B1) 4300 Cherry Creek Drive South
Denver, CO. 80246-1530 Attention: Allan Smith, Purchasing Agent
Direct Telephone Inquiries To: Allan Smith at (303) 692-2072
PLEASE TYPE OR PRINT INFORMATION
FEDERAL EMPLOYER’S IDENTIFICATION (FEIN) #: _____________________________________________________________
VSS Registration Number _________________________________________________________________________________
COMPANY NAME: ________________________________________ DBA (if applicable): ____________________________
ADDRESS: __________________________________________________________________________________________
CITY, STATE, ZIP: _____________________________________________________________________________________
TYPED OR PRINTED NAME: ____________________________________________________________________________
HANDWRITTEN SIGNATURE OF AUTHORIZED COMPANY OFFICER / AGENT
SIGNING OFFICER / AGENT TITLE: _______________________________________________________________________
SIGNATURE DATE: ____________________________________________________________________________________
E-MAIL ADDRESS: ____________________________________________________________________________________
PHONE #: __________________________________________ FAX #: ___________________________________________
POINT OF CONTACT FOR SOLICITATION-RELATED COMMUNICATIONS:
NAME______________________________________________ PHONE #: ______________________________________
E-MAIL: _____________________________________________________________________________________________
SUBMIT SIGNED ORIGINAL OF THIS FORM WITH ORIGINAL SOLICITATION RESPONSE
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