Exhibit C - Vendor Contact Information Sheet.docx
DOCX document 2 MB Posted
- Attached to
- Child Care Licensing Inspections
- Solicitation number
- RFP QAAA 2026000189 4
- Issued by
- Arapahoe County, Colorado
About this file
This is a Vendor Contact Information Sheet from the Colorado Department of Early Childhood (CDEC) designed to collect essential administrative and operational details from vendors seeking to contract with the state agency. The form captures vendor identification information including legal business name, physical and mailing addresses, federal tax identification numbers, state incorporation details, and fiscal year end dates. It requires all vendors except individuals to provide a SAM.gov Unique Entity Identification (UEI) number and documents vendor status as new or existing to CDEC. The form also collects information regarding current or former state employee staffing within the last six months and federally or state-negotiated indirect cost rates.
The form establishes contact protocols by designating primary, financial, invoice, and signing contacts with their respective titles, email addresses, and phone numbers, along with provisions for additional contacts and their specific DocuSign roles in the contract execution process. Vendors must specify their entity type, whether they are set up for Electronic Fund Transfer (EFT) with the state, and provide preliminary review and signing timelines. The document includes sections for special instructions to facilitate the approval and DocuSign execution process smoothly, accommodating various internal approval routing requirements such as attorney or program manager review before contract signing.
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Text version
Colorado Department of Early Childhood Vendor Contact Information Sheet
| Question or Information Needed: |
| Answer: |
Legal Name of Vendor as it should appear on the Contract/Purchase Order including any doing business as (dba):
Street Address including City, State and Zip Code:
Mailing Address including City, State and Zip Code (if different from Street Address):
County Agency is in:
Federal Entity Identification Number (FEIN) or Tax ID Number (TIN):
State of Incorporation:
Secretary of State Identification/Document Number:
Fiscal Year End Date (Month and Day – format MM/DD):
All Vendors must have a SAM.gov Unique Entity Identification (UEI) number (except individuals). SAM UEI number:
| Are you a new vendor working with CDEC? | |||
| ☐ | Yes | ☐ | No |
Does your Agency hire any current or former State Employees to work on this project?
If yes, did they end employment with the State within the last 6 months?
Does your agency have a Federally Negotiated or State Negotiated indirect Rate?
If yes, please send a copy of the approval letter with this form.
| What type of Entity is your Agency? | ||
| ☐ | Individual | |
| ☐ | Professional Corporation (PC) | |
| ☐ | Sole Proprietor | |
| ☐ | Not-for-Profit Corporation | |
| ☐ | Limited Liability Company (LLC) | |
| ☐ | Joint Venture | |
| ☐ | For-Profit | |
| ☐ | Limited Liability Partnership (LLP) | |
| ☐ | Government |
| Question or Information Needed: |
| Answer: |
Primary Contact to Receive ALL Correspondence’s Name:
Primary Contact’s Title:
Primary Contact’s Email Address:
Primary Contact’s Phone Number:
Financial Contact’s Name:
Financial Contact’s Title:
Financial Contact’s Email Address:
Financial Contact’s Phone Number:
Invoice Contact’s Name:
Invoice Contact’s Title:
Invoice Contact’s Email Address:
Invoice Contact’s Phone Number:
Individual Signing the Contract’s Name:
Individual Signing the Contract’s Title:
Individual Signing the Contract’s Email Address:
Individual Signing the Contract’s Phone Number:
Please list any special instructions for your agency to make the preliminary approval and DocuSign process run smoothly. Examples:
· Please send request for preliminary approval to Primary Contact only.
· Someone needs to approve the document before it goes to the signer such as an attorney or program manager;
· Enter the internal routing number in the note in DocuSign for the Individual Signing the Contract.
Specific Notes/Requests:
Additional Contact’s Name:
Additional Contact’s Title:
Additional Contact’s Email Address:
Additional Contact’s Phone Number:
| What does this Additional Contact need to do (check all that apply)? | ||
| ☐ | Email - Receive the document for preliminary approval | |
| ☐ | DocuSign - Receive Copy Prior to Signer | |
| ☐ | DocuSign - Approve Prior to Signer | |
| ☐ | DocuSign - Sign Prior to Signer | |
| ☐ | DocuSign - Sign after Signer | |
| ☐ | DocuSign - Receive Copy upon execution |
| Is your agency set up for Electronic Fund Transfer (EFT) with the State of Colorado? | |||
| ☐ | Yes | ☐ | No |
If yes, please list the last 4 digits of the account number payments should be sent to:
How long does your agency and/or board need to complete a preliminary review of the contract?
How long does your agency and/or board need to sign the contract in DocuSign?
Date This Form Was Completed:
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