Exhibit C - Vendor Contact Information Sheet.docx
DOCX document 749 KB Posted
- Attached to
- Reflective Consultation for EI Care Navigators
- Solicitation number
- DQ1 QAAA 2027000018 1
- Issued by
- Arapahoe County, Colorado
About this file
This is a Vendor Contact Information Sheet from the Colorado Department of Early Childhood (CDEC) for the contract opportunity titled "Reflective Consultation for EI Care Navigators." The form serves as a standardized template for vendors to provide essential business, organizational, and contact information required to execute a contract with CDEC. The document collects comprehensive vendor details including legal business name, physical and mailing addresses, federal tax identification numbers, state incorporation information, and SAM.gov Unique Entity Identification (UEI) numbers. The form requires vendors to identify their entity type—whether they are individuals, sole proprietors, professional corporations, limited liability companies, not-for-profit corporations, for-profit entities, limited liability partnerships, joint ventures, or government agencies. Additionally, vendors must disclose whether they are new to CDEC, whether they employ current or former state employees who separated within the past six months, and whether they have federally or state-negotiated indirect cost rates.
The form establishes a structured contact hierarchy requiring vendors to designate primary, financial, and invoice contacts along with the individual authorized to sign the contract, each with corresponding titles, email addresses, and phone numbers. CDEC utilizes DocuSign for contract execution and the form allows vendors to identify additional signatories and specify their role in the approval process. Vendors must indicate whether they have Electronic Fund Transfer (EFT) capabilities with the State of Colorado and provide the last four digits of their account number if applicable. The form also requests timeline information regarding preliminary contract review and DocuSign signature completion periods, as well as any special routing or approval instructions necessary for the vendor's internal processes.
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Text version
Colorado Department of Early Childhood Vendor Contact Information Sheet 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 |
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:
The Colorado Department of Early Childhood Collects signatures via DocuSign. Please list below any individuals that need to be included in the DocuSign process (examples: Director’s Assistant, Attorney, etc.)
Additional Contact’s Name:
Additional Contact’s Title:
Additional Contact’s Email Address:
Additional Contact’s Phone Number:
| What does this person need to do? | ||||
| ☐ | Sign before Individual Signing | Contract and receive a copy upon | execution | |
| ☐ | Sign after Individual Signing | Contract and receive a copy upon | execution | |
| ☐ | Receive Copy Prior to Signer and | upon execution | ||
| ☐ | Approve Prior to Signer and receive | a copy upon execution | ||
| ☐ | Receive Copy upon execution only |
Are there any specific instructions for emails requesting preliminary approval or order of DocuSign for signature (examples: enter the internal routing number in the note in DocuSign for the Individual Signing the Contract; Please send in DocuSign in the following order; Please send for preliminary approval to Primary Contact only; etc.)?
| 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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