Solicitation no_IFB1_FAAA_2016000256_Custom Trailer_Vendor Information Cofirmation of Offer Form.pdf.docm
DOCM document 39 KB Posted
- Solicitation number
- IFB1 FAAA 2016000256 2
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a Vendor Information Form and Confirmation of Offer for Solicitation No. IFB1 FAAA 2016000256, issued by the Colorado Department of Public Health and Environment (CDPHE) Air Pollution Control Division. The solicitation seeks a custom-built mobile laboratory trailer. Proposals are due on March 29, 2016 at 2:00 PM Mountain Time and must be submitted to the Colorado Department of Public Health and Environment Purchasing and Contracts Section at 4300 Cherry Creek Drive South, Denver, Colorado 80246-1530, attention Timothy Massangale, CPPB, Senior Purchasing Agent. Inquiries regarding the solicitation should be directed to Timothy Massangale at (303) 692-2072.
The form requires vendors to provide company information including vendor customer number from Colorado VSS, Federal Employer's Identification Number, DUNS number if applicable, company name and DBA, complete address, authorized signatory details, email address, phone and fax numbers, and a point of contact for solicitation-related communications. All information must be typed or printed, and the form must be signed by an authorized company officer or agent and submitted as the original with the original solicitation response.
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Text version
Exhibit A
Solicitation #: IFB1 FAAA 2016000256 Title:Mobile Laboratory Custom Built Trailer for: CDPHE Air Pollution Control Division
Vendor Information Form & Confirmation of Offer
PROPOSAL DUE DATE: MARCH 29, 2016 2:00 PM MT
Responses must be clearly marked with SOLICITATION #, SUBMISSION DEADLINE DUE 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 Purchasing and Contracts Section Building Operations (B1) 4300 Cherry Creek Drive South Denver, CO. 80246-1530 Attention: Timothy Massangale, CPPB, Senior Purchasing Agent
Direct Telephone Inquiries To: Timothy Massangale 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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