Exhibit C Vendor Info Form.pdf
PDF 27 KB Posted
- Solicitation number
- DQ1 FAAA 2017000078 1
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a Vendor Information Form and Confirmation of Offer submitted to the Colorado Department of Public Health & Environment for Solicitation #DQ1-FAAA-2017-78, a Laboratory Deionized Water System Maintenance and Repair Service contract. The solicitation requires vendors to submit responses by August 16, 2016 at 2:00 pm to the Colorado Department of Public Health & Environment Contracts and Purchasing Unit Mail Room at 4300 Cherry Creek Drive South in Denver, Colorado. Responses must be clearly marked with the solicitation number, submission deadline date, and time on the outside of the submittal package. All responses are subject to the conditions stipulated in the solicitation and specifications provided by the state.
Vendors must complete the Vendor Information Form with company identification details including Colorado Vendor Self-Service (VSS) customer number, Federal Employer's Identification Number (FEIN), DUNS number if applicable, company name and doing-business-as designation, full business address, contact information, and authorized signatory information. The form requires a typed or printed name and handwritten signature from an authorized company officer or agent, along with the signatory's title and date of signature. Vendors must provide a designated point of contact for solicitation-related communications with corresponding phone number and email address. The signed original form must be submitted with the original solicitation response package.
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Text version
Exhibit C
Solicitation #: DQ1-FAAA-2017-78 Title: Laboratory Deionized Water System Maintenance and Repair
Service
Vendor Information Form & Confirmation of Offer
SUBMISSION DEADLINE DATE: August 16, 2016 at 2:00 pm
Responses must be clearly marked with SOLICITATION #, SUBMISSION DEADLINE 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, Senior Purchasing Agent
Direct Telephone Inquiries To: NAME at (303) 692-2106
PLEASE TYPE OR PRINT INFORMATION
VENDOR CUSTOMER # (From Colorado VSS):___________________________________________________________________
FEDERAL EMPLOYER’S IDENTIFICATION (FEIN) #: _______________________________________________________________
DUNS # (if applicable): ____________________________________________________________________________________
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
| Vendor Information Form & Confirmation of Offer |
| RETURN SOLICITATION RESPONSE AND THIS FORM TO: |
| Direct Telephone Inquiries To: NAME at (303) 692-2106 |
File details come from the government source that posted it. Updated .