Solicitation no_ DQ1 FAAA FHLA201600001_Ex. A_Vendor Information - Confirmation of Offer Form.pdf.docm
DOCM document 39 KB Posted
- Solicitation number
- DQ1 FAAA FHLA2016000000000001 2
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a Vendor Information Form and Confirmation of Offer submission document issued by the Colorado Department of Public Health and Environment for Solicitation #DQ1 FAAA FHLA201600001, concerning WIC EBT Magnetic Stripe Readers. The solicitation requires vendors to submit responses by February 3, 2016, at 2:00 PM Mountain Time to the Colorado Department of Public Health and Environment Contracts and Purchasing Unit Mail Room at 4300 Cherry Creek Drive South, Denver, CO 80246-1530. Inquiries regarding the solicitation should be directed to Timothy Massangale, CPPB, Senior Purchasing Agent, at (303) 692-2072. The form must be completed with vendor contact information and submitted as a signed original alongside the original solicitation response.
The form requests standard vendor identification information including Colorado VSS customer number, Federal Employer's Identification Number, DUNS number, company name and DBA, business address, authorized signatory details, and point of contact information for solicitation-related communications. Vendors must provide their email address, phone number, and fax number on the form. All required information must be typed or printed, and the form must bear the handwritten signature of an authorized company officer or agent along with the signature date.
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Other files
| File | Type | Posted |
|---|---|---|
| Solicitation no_DQ1 FAAA FHLA201600001_Mag stripe reader initial shipment addresses.xlsx | XLSX spreadsheet | |
| PO_Terms_&_Conditions_1-1-09.pdf | ||
| Solicitation no_ DQ1 FAAA FHLA201600001_ Mag Stripe Readers_specifications.pdf.doc | DOC document |
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Text version
Exhibit A
Solicitation #: DQ1 FAAA FHLA201600001 Title: WIC EBT Magnetic Stripe Readers
Vendor Information Form & Confirmation of Offer
SUBMISSION DEADLINE: 02/03/2016 2:00 PM MT
Responses must be clearly marked with SOLICITATION #, SUBMISSION DEADLINE DATE and TIME on the outside of the submittal. Responses submitted subject to the conditions stipulated herein and in accordance with the specifications set forth in the solicitation will be accepted at the address listed below prior to the submittal deadline.
RETURN SOLICITATION RESPONSE AND THIS FORM TO:
Colorado Department of Public Health & Environment Contracts and Purchasing Unit Mail Room (B1) 4300 Cherry Creek Drive South Denver, CO. 80246-1530 Attention: NAME, Purchasing Agent
Direct Telephone Inquiries To: Timothy Massangale, CPPB, Senior Purchasing Agent at (303) 692-2072
PLEASE TYPE OR PRINT INFORMATION
VENDOR CUSTOMER # (From Colorado VSS):___________________________________________________________________
FEDERAL EMPLOYER’S IDENTIFICATION (FEIN) #: _______________________________________________________________
DUNS # (if applicable): ____________________________________________________________________________________
COMPANY NAME: ________________________________________ DBA (if applicable): ______________________________
ADDRESS: ______________________________________________________________________________________________
CITY, STATE, ZIP: _______________________________________________________________________________________
TYPED OR PRINTED NAME: _______________________________________________________________________________
HANDWRITTEN SIGNATURE OF AUTHORIZED COMPANY OFFICER / AGENT
SIGNING OFFICER / AGENT TITLE: _________________________________________________________________________
SIGNATURE DATE: ______________________________
E-MAIL ADDRESS: ______________________________________________________________________________________
PHONE #: __________________________________________ FAX #: ___________________________________________
POINT OF CONTACT FOR SOLICITATION-RELATED COMMUNICATIONS:
NAME______________________________________________ PHONE #: ______________________________________
E-MAIL: _____________________________________________________________________________________________
SUBMIT SIGNED ORIGINAL OF THIS FORM WITH ORIGINAL SOLICITATION RESPONSE
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