Exhibit G - Vendor Contact Information Sheet.docx
DOCX document 473 KB Posted
- Attached to
- FY26 MIECHV RFP Solicitation
- Solicitation number
- RFP QAAA 2027000003 3
- Issued by
- Arapahoe County, Colorado
About this file
This is a Vendor Contact Information Sheet issued by the Colorado Department of Early Childhood (CDEC) for the FY26 MIECHV RFP Solicitation. The form serves as a standardized template for collecting essential vendor information required to establish and maintain contractual relationships with the state. The document requests comprehensive details about prospective vendors, including legal entity information, federal and state identification numbers, and organizational structure classification options ranging from individuals and sole proprietorships to not-for-profit corporations, for-profit entities, limited liability companies, and government agencies.
The form requires vendors to designate multiple points of contact for different functions within the contracting process, including a primary contact for general correspondence, a financial contact, an invoice contact, and the individual authorized to sign the contract. Each contact must provide name, title, email address, and phone number. The document also requests information regarding vendor status as new or existing, employment of current or former state employees, negotiated indirect rates, Electronic Fund Transfer (EFT) setup with Colorado, and timeline requirements for preliminary contract review and DocuSign execution. Additionally, vendors must confirm possession of a SAM.gov Unique Entity Identification (UEI) number and may provide special instructions or designate additional contacts with specific roles in the preliminary approval and DocuSign process.
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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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