Exhibit E Vendor Contact Information Sheet.docx
DOCX document 153 KB Posted
- Solicitation number
- RFP QAAA 2026000153 4
- Issued by
- Arapahoe County, Colorado
About this file
This is a Vendor Contact Information Sheet form used by the Colorado Department of Early Childhood (CDEC) to collect essential vendor information for state contract and purchase order purposes. The form serves as a standardized intake document for vendors seeking to do business with CDEC, particularly in connection with the HealthySteps Program Implementation Sites Solicitation. The form requests comprehensive vendor identification details, including legal business name, physical and mailing addresses, federal tax identification numbers, state incorporation information, and the vendor's Unique Entity Identification (UEI) number from SAM.gov. Additionally, the form gathers information regarding vendor status as new or existing, employment of current or former state employees, and possession of federally or state-negotiated indirect cost rates, along with vendor entity type classification options ranging from individuals and sole proprietors to corporations, limited liability companies, and joint ventures.
The form establishes a framework for identifying key vendor contacts across multiple functional areas, including a primary contact for general correspondence, separate financial and invoice contacts, and the individual authorized to sign the contract on behalf of the vendor. CDEC utilizes DocuSign for electronic signature collection, and the form accommodates specification of additional signatories who may need to review or approve the contract prior to or following the primary signatory's execution. The form also collects critical operational information, including Electronic Fund Transfer (EFT) setup status with the State of Colorado and account details for payment processing, as well as the vendor's timeline requirements for preliminary contract review and DocuSign signature completion. This intake form ensures standardized documentation and streamlined administrative processing for all vendors entering into contractual relationships with the Colorado Department of Early Childhood.
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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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