Exhibit E - Vendor Contact Information Sheet.docx
DOCX document 153 KB Posted
- Solicitation number
- RFP QAAA 2026000215 3
- Issued by
- Arapahoe County, Colorado
About this file
This is a Vendor Contact Information Sheet form required by the Colorado Department of Early Childhood for vendors seeking to contract on the Promoting Safe and Stable Families (PSSF) Services opportunity. The form collects comprehensive vendor identification and contact information necessary for contract execution and ongoing project management, including the vendor's legal name, business address, federal tax identification number, state of incorporation, and SAM.gov Unique Entity Identification number. The document requires vendors to identify their entity type—whether an individual, sole proprietor, not-for-profit corporation, for-profit entity, professional corporation, limited liability company, joint venture, or limited liability partnership—and to disclose whether they are a new vendor to the Colorado Department of Early Childhood or have previously hired current or former state employees within the last six months.
The form establishes designated points of contact for all project correspondence, including a primary contact for general communications, a financial contact for accounting matters, an invoice contact for billing purposes, and the individual authorized to sign the contract. The document also provides a mechanism for identifying additional signatories required through the state's DocuSign process, with options to specify whether additional contacts must sign before or after the primary contract signer, approve prior to signing, or receive copies at various stages. Vendors must confirm their setup for Electronic Fund Transfer with the state and provide their preliminary review and signature turnaround timelines. The form requires submission of supporting documentation, including evidence of any federally or state-negotiated indirect cost rates if applicable, and establishes that all vendors, except individuals, must possess an active SAM.gov UEI number.
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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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