24-0005 ExhibitA-2-Bidder'sProfile.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

Provide Bidder’s Registration Number UBI Number issued by the Washington State Department of Revenue in the space provided:

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 (SNN)). If Bidder’s TIN is a SSN, do NOT provide the SSN; simply state ‘TIN is Bidder’s SSN’ in the space provided.

SUBCONTRACTORS

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): ____________

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)?

Bidder does NOT qualify as a Small Busines 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 your firm 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:

Address for Enterprise Services to send legal notices:

Company name:

Attn:

Address:

City/State/Zip:

Email: _______________

Signature Authority (if awarded a contract) Name:

Title:

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:

descprminternal@des.wa.gov

EXHIBIT A-2 – BIDDER’S PROFILE: 24-0005 – FACILITY TECHNOLOGY MODERNIZATION PAGE 1 (Rev 2024-07-23) image1.png image2.jpeg