14822 Exhibit A-2 - Bidder's Profile.docx

EXHIBIT A-2 – BIDDER’S PROFILE

IT Project Manager Services ☐Category B Quality Assurance Services

☐ Senior Level ☐ Expert Level ☐ Journey Level ☐ Senior Level ☐ Expert Level

Type/print full legal name of Bidder

BIDDER INFORMATION

Legal name of Bidder:

Address of Bidder:

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

Business Name Address City, State, Zip Code

Bidder’s Washington State Department of Revenue Registration Number/Unified Business Identifier (UBI) Number:

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

Taxpayer Identification No. (TIN):

Note: Your 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., your Social Security Number). Do Not provide a Social Security Number.

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

Is your firm a self-certified Washington State Small Business?

Note: See Exhibit A-1 – Bidder’s Certification for criteria to qualify as a Washington State 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 your business size (based on annual gross revenue)?

Is your firm certified as a Veteran-Owned Business with the Washington State Department of Veteran Affairs?

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:

Address for Enterprise Services to send legal notices:

Company name:

Attn:

Address:

City/State/Zip:

ORDERING/SALES POINTS OF CONTACT (expand as necessary)

SUBCONTRACTORS (expand as necessary) Bidder must identify all subcontractors utilized in completing work under resulting contract.

Note: If the TIN is a SSN, do NOT provide SSN.

Services provided

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

Entity Name:

Contact:

Phone:

Email:

REFERENCE 2

Entity Name:

Contact:

Phone:

Email:

REFERENCE 3

Entity Name:

Contact:

Phone:

Email:

Return this Bidder’s Profile to Procurement Coordinator at:

DESITPS@des.wa.gov.

EXHIBIT A-2 – BIDDER’S PROFILE: 14822-IT PROJECT MANAGEMENT SERVICES PAGE 1

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