03724_ExhibitA-2-Bidder'sProfileV2.docx

EXHIBIT A-2 – BIDDER’S PROFILE

Type/print full legal name of Bidder

BIDDER INFORMATION

BIDDER’S LEGAL NAME & ADDRESS

Provide Bidder’s legal name and address in the space provided:

Note: This information must match the information from Bidder’s Business License.

Business Name Address City, State, Zip Code

BIDDER’S UNIFIED BUSINESS IDENTIFIER (“UBI”) NUMBER

Does Bidder have a Registration Number/Unified Business Identifier (“UBI”) Number issued by the Washington State Department of Revenue (check applicable box)?

Note: A nine digit UBI number is assigned to each registered business in Washington.

Yes |_| No |_| If yes, provide Bidder’s UBI Number: ___ ___ ___ If no, state whether Bidder promptly will obtain a UBI Number issued by the Washington State Department of Revenue if designated as an Apparent Successful Bidder:

Yes |_| No |_| Note: To be eligible for a Contract award, bidders must have a UBI Number issued by the Washington State Department of Revenue.

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.: ____________

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)?

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:

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)

REFERENCES

Provide at least one (1) reference for each of three (3) different contracts for which bidder has provided/performed goods and/or services similar in scope to the goods/services described in the above-referenced Competitive Solicitation. Note: It is Bidder’s obligation to ensure that the contact information for Bidder’s references is accurate and current. Bidders should alert their references to respond promptly to reference checks.

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: 03724 – VARIABLE MESSAGE BOARDS PAGE 1

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