2.3_Exhibit A-2_BiddersProfile_2024-05.docx

EXHIBIT A-2 – BIDDER’S PROFILE

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.

Does Bidder intent to utilize subcontractors to perform the Contract, if awarded?

Note: If Bidder intends to utilize subcontractors, Bidder must identify Bidder’s intended subcontractors.

Yes |_| No |_| If yes, provide Bidder’s anticipated subcontractor(s): ____________

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:

Address for WTSC to send legal notices:

Company name:

Attn:

Address:

City/State/Zip:

Signature Authority (if awarded a contract) Name:

Title:

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:

WILL CALL/SERVICE LOCATIONS

Identify will call or service locations throughout the state.

SUBCONTRACTORS

If utilizing subcontractors, please identify all subcontractors that would provide services under a resulting contract.

SUBCONTRACTORS (EXPAND AS NECESSARY)

Bidder must identify all subcontractors utilized in completing work under resulting contract. Bidder must notify PERC of any changes in subcontractors, (additions/deletions) using the same form before commencing any work with new subcontractors under the resulting contract. PERC reserves the right to approve or deny any subcontractors.

Return this Bidder’s Profile to Procurement Coordinator at:

awilliams@wtsc.wa.gov

EXHIBIT A-2 – BIDDER’S PROFILE: NO. 2024-05_TRAINING POSITIVE COMMUNITY FRAMEWORK PAGE 1 (Rev 2023-05-15) image1.png image2.jpeg