RFQ26-25, Exhibit D.docx
DOCX document 22 KB Posted
- Solicitation number
- #026-25
- Issued by
- Douglas County, Colorado
About this file
Exhibit D is a Vendor Information Sheet from the Douglas County Department of Human Services in Colorado, seeking qualified vendors for client and staff goods and services through a Request for Qualifications (RFQ26-25). The solicitation aims to create a short-list of vendors across multiple service categories, with the county intending to have at least three responses per category. Vendors will be evaluated based on specified criteria, and while being short-listed does not guarantee a contract, it positions vendors for potential selection for Public Contracts for Services as needed.
The document requires detailed vendor information including legal name, contact details, federal/state/county funding sources, and potential conflicts of interest. Vendors must disclose current contracts, grants, or funding from other government entities and declare any potential conflicts such as prior client relationships, connections to county employees, or outside arrangements that could create oppositional interests. The vendor information sheet allows multiple contact designations including contract, program services, and invoice contacts, enabling comprehensive communication channels for potential service procurement.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFQ26-25, Exhibit B.docx | DOCX document | |
| RFQ26-25, Exhibit C.docx | DOCX document | |
| RFQ26-25.pdf | ||
| RFQ26-25, Exhibit A.docx | DOCX document | |
| RFQ26-25, Exhibit E.docx | DOCX document |
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Text version
Exhibit D ~ Vendor Information Sheet
1) Legal Name:
2) DBA:
3) Legal Address (not necessarily site of all service delivery):
4) Business Phone:
5) Facsimile:
6) Website:
7) Other Federal, State and County Funding (excluding Medicaid reimbursement)
a) Please list all current contracts, grants, or funding with any federal, state or county (including non-Human Services Douglas County Departments or programs) for this same service(s)? The Department will seek additional information prior to finalizing a decision.
8) Conflicts
a) Please indicate if you know or believe you or the organization have any conflicts of interest. Examples include, but are not limited to: 1) you or someone providing services is a past or current Department of Human Services client, 2) you or someone providing services is related to, or a close acquaintance of a current Department of Human Services employee, or 3) you or someone providing services has an outside business, government, volunteer or personal arrangement that could generate oppositional or contrary interests to the County.
Yes ☐ No ☐ If yes, the Department will seek additional information prior to finalizing a decision.
9) Contract Contact (Name of person who may sign a contract.)
a) Name:
b) Title:
c) E-mail:
d) Phone number:
10) Program or Services Contact 1 (If same as above, skip.)
a) Name:
b) Title:
c) E-mail:
d) Phone number:
11) Program or Services Contact 2 (If none, skip.)
a) Name:
b) Title:
c) E-mail:
d) Phone number:
12) Program or Services Contact 3 (If none, skip.)
a) Name:
b) Title:
c) E-mail:
d) Phone number:
13) Invoice Contact
a) Name:
b) Title:
c) E-mail:
d) Phone number:
File details come from the government source that posted it. Updated .