Exhibit G - Vendor Contact Information Sheet.docx
DOCX document 473 KB Posted
- Attached to
- FY26 MIECHV RFP Solicitation
- Solicitation number
- RFP QAAA 2027000003 2
- Issued by
- Arapahoe County, Colorado
About this file
This is a Vendor Contact Information Sheet form issued by the Colorado Department of Early Childhood (CDEC) for use by vendors seeking to contract with the state. The form serves as a standardized template to collect essential vendor identification, contact, and administrative information required for contract establishment and ongoing correspondence. The document does not pertain to specific products, services, project scopes, quantities, response dates, award dates, or contract terms, as it functions solely as an information-gathering instrument rather than a solicitation or contract award notice.
The form requires vendors to provide legal entity information including business name, addresses, federal tax identification numbers, state incorporation details, and SAM.gov Unique Entity Identification (UEI) numbers. Additionally, vendors must designate primary contacts for general correspondence, financial matters, and invoice processing, along with identifying the authorized contract signatory. The form requests information regarding vendor status as new or incumbent, hiring of current or former state employees, indirect cost rate agreements, entity type classification, and Electronic Fund Transfer (EFT) setup status with the State of Colorado. Vendors are also permitted to provide special instructions and routing information to facilitate the preliminary approval and DocuSign execution process, as well as identify additional contacts with specified roles in the contract approval and signing workflow.
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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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