00224 ExhibitA-2-Bidder'sProfile-Draft.pdf

EXHIBIT A-2 – BIDDER’S PROFILE: 00224 – AUDIO-VISUAL SOLUTIONS PAGE 1

(Rev 2024-07-22)

EXHIBIT A-2 – BIDDER’S PROFILE

Competitive Solicitation: No. 00224 – Audio-Visual Solutions

Bidder: ___________________________ Type/print full legal name of Bidder

BIDDER INFORMATION

BIDDER’S TAXPAYER IDENTIFICATION NUMBER (“TIN”)

Provide Bidder’s TIN in the space provided:

Note: Bidder’s TIN will be either a number issued by the IRS (e.g., Employer Identification Number, Federal Tax Identification Number) or a number issued by the Social Security Administration (i.e., Bidder’s Social Security Number(“SSN”)). If Bidder’s TIN is a SSN, do NOT provide the SSN; simply state ‘TIN is Bidder’s SSN’ in the space provided.

OMWBE CERTIFIED BUSINESS

Is Bidder certified as a minority or woman owned business with the Washington State Office of Minority & Women’s Business Enterprises (“OMWBE”) (check applicable box)?

Yes No

If yes, provide Bidder’s OMWBE certification no.: ____________

EXHIBIT A-2 – BIDDER’S PROFILE: 00224 – AUDIO-VISUAL SOLUTIONS PAGE 2

BIDDER INFORMATION

SELF-CERTIFIED WASHINGTON SMALL BUSINESS

Is Bidder a self-certified Washington Small Business (check applicable box)?

Note: See Exhibit A-1 – Bidder’s Certification for criteria to qualify as a Washington Small Business.

Note: Regardless of size, a qualifying business must be owned and operated independently from all other businesses. In regard to size, the gross revenue thresholds, as reported on Bidder’s tax returns, are as follows:

▪ Microbusiness: Annual gross revenue of less than one million dollars.

▪ Minibusiness: Annual gross revenue of more than one million dollars, but less than three million dollars.

▪ Small Business: Annual gross revenue of less than seven million dollars over each of the three prior consecutive years.

Yes No

If yes, provide the location for Bidder’s principal place of business:

Street Address City, State, Zip Code

If yes, what is Bidder’s size (based on annual gross revenue) (check applicable box)?

Microbusiness

Minibusiness

Small Business

Or

Bidder does NOT qualify as a Small Business based on annual gross revenue, but DOES qualify as a Small Business based on the number of Bidder’s employees (50 or fewer):

Small Business (50 or fewer employees)

CERTIFIED VETERAN-OWNED BUSINESS

Is Bidder certified as a Veteran-Owned Business with the Washington State Department of Veteran Affairs (“WDVA”) (check applicable box) ?

Note: See Exhibit A-1 – Bidder’s Certification for criteria to qualify as a Certified Veteran-Owned Business.

Yes No

If yes, provide Bidder’s WDVA certification no.:

CONTRACT MANAGEMENT POINTS OF CONTACT FOR BIDDER

Authorized Representative

Name:

Email:

Phone:

Contract Administrator

Name:

Email:

Phone:

Sales Reporting Representative

Name:

Email:

Phone:

Sales Reporting Alternate

Name:

Email :

Phone:

EXHIBIT A-2 – BIDDER’S PROFILE: 00224 – AUDIO-VISUAL SOLUTIONS PAGE 3

CONTRACT MANAGEMENT POINTS OF CONTACT FOR BIDDER

Management Fee Representative

Name:

Email:

Phone:

Management Fee Contact Alternate

Name:

Email:

Phone:

Address for Enterprise Services to send management fee invoices:

Company name:

Attn:

Address:

City/State/Zip:

Email: ___________

Address for Enterprise Services to send legal notices:

Company name:

Attn:

Address:

City/State/Zip:

Email: ____________

Signature Authority (if awarded a contract)

Name:

Title:

ORDERING/SALES POINTS OF CONTACT (expand as necessary)

Name Phone Number E-mail Area of Responsibility

EXHIBIT A-2 – BIDDER’S PROFILE: 00224 – AUDIO-VISUAL SOLUTIONS PAGE 4

WILL CALL/SERVICE LOCATIONS

Identify will call or service locations throughout the state.

LOCATION POINT OF CONTACT PHONE NUMBER AREA(S) OF RESPONSIBILITY

PURCHASE CARDS (I.E., CREDIT CARDS)

Please indicate which types of purchasing (credit) cards are accepted (note: any card fees must be included in the unit price of the bid):

Visa Master Card American Express Discover Other:

Return this Bidder’s Profile to Procurement Coordinator at:

DESContractsTeamCypress@des.wa.gov mailto:DESContractsTeamCypress@des.wa.gov