03020 Exhibit A-2.docx

EXHIBIT A-2 – BIDDER’S PROFILE

Bidder:

BIDDER INFORMATION

Legal name and address of Bidder:

Note: This must match information from Business License Business Name Address City, State, Zip Code

Washington State Department of Revenue Registration Number:

Note: This is the Unified Business Identifier (UBI)

Federal Tax ID No. (TIN):

Note: If your TIN is a Social Security number, provide only the last four digits.

If yes, provide MWBE certification no. ________

Is your firm a self-certified Washington State small business?

Note: See definitions of ‘microbusiness,’ ‘minibusiness,’ and ‘small business,” set forth in RCW 39.26.010.

Yes |_| No |_| If yes, what is your business size?

Small |_| Mini |_| Micro |_|

If yes, provide WSDVA certification no. __________.

CONTRACT MANAGEMENT POINTS OF CONTACT

Authorized Representative Name:

Email:

Phone:

Contract Administrator Name:

Email:

Phone:

Sales Reporting Representative Name:

Email:

Phone:

Sales Reporting Alternate Name:

Email :

Phone:

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:

ORDERING/SALES POINTS OF CONTACT (expand as necessary)

REFERENCES

Provide a minimum of three (3) commercial or government references for which bidder has delivered goods and/or services similar in scope as described in the Competitive Solicitation.

Reference 1

Company Name:

Contact:

Phone:

Email:

Reference 2

Company Name:

Contact:

Phone:

Email:

Reference 3

Company Name:

Contact:

Phone:

Email:

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:

DESContractsTeamCedar@des.wa.gov

EXHIBIT A-2 – BIDDER’S PROFILE

SOLICITATION NO. 03020 – LAMPS, BALLASTS, RETROFIT KITS, REPLACEMENT FIXTURES, AND LAMP RECYCLING PAGE 1 (Rev 2020-02-24) image1.jpeg image2.jpeg