Vendor Info Form.docm
DOCM document 17 KB Posted
- Solicitation number
- DQ1 FAAA FEEA2015000000000001 4
- Issued by
- Rio Grande County, Denver City, Colorado
About this file
This is a Vendor Information Form and Confirmation of Offer from the Colorado Department of Public Health and Environment for solicitation FAAA FEEA2015000000000001, titled "SV-103 Summitville Mine Dam: Toe Seep Modifications." The form serves as the submission document for vendors responding to this state contract opportunity. Responses must be submitted to the Colorado Department of Public Health & Environment Contracts and Purchasing Unit Mail Room at 4300 Cherry Creek Drive South, Denver, Colorado 80246-1530, addressed to Sam Fuller, Purchasing Agent, prior to the solicitation deadline. Direct inquiries regarding the solicitation should be directed to sam.fuller@state.co.us.
The form requires vendors to provide standard business identification information, including company name, Federal Employer's Identification Number (FEIN), DUNS number if applicable, complete address, and Colorado Vendor Self-Service (VSS) customer number. Respondents must designate an authorized company officer or agent to sign the form and provide contact information for the signatory, including title, signature date, email address, and phone number. Additionally, vendors must identify a point of contact for solicitation-related communications with associated phone number and email address. The completed and signed original form must be submitted with the original solicitation response as a required component of the bid package.
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Text version
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
Vendor Information Form / Confirmation of Offer
SOLICITATION #: FAAA FEEA2015000000000001
SOLICITATION NAME: SV-103 Summitville Mine Dam: Toe Seep Modifications
Responses must be clearly marked with SOLICITATION #, 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 Contracts and Purchasing Unit Mail Room (B1) 4300 Cherry Creek Drive South Denver, CO. 80246-1530 Attention: Sam Fuller, Purchasing Agent
Direct Inquiries To: sam.fuller@state.co.us
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
File details come from the government source that posted it. Updated .