ATTACHMENT F7 - Preliminary Security Questionnaire.pdf
PDF 129 KB Posted
- Attached to
- RFP 16073 - Marketing Technology Services
- Solicitation number
- S-177000-00005746
- Issued by
- Marion County, Oregon
About this file
The document is a Preliminary Security Questionnaire for vendors submitting proposals to the Oregon Lottery. The questionnaire requests general business information such as the vendor's name, address, tax ID, and a description of the products or services to be provided. It also asks the vendor to list all officers, owners, shareholders, directors, members, and partners, as well as any subcontractors that will be used to a substantial degree. The majority of the work is to be performed within the state of Oregon.
The related state and local contract opportunity is RFP 16073 - Marketing Technology Services, which involves Marion County and the City of Salem. This contract opportunity likely involves the provision of marketing technology services to support the lottery operations in those jurisdictions. The response and due dates, award dates, and contract term are not provided in the given information.
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Text version
VENDOR PROCUREMENT
Security Preliminary Questionnaire
Vendor Procurement: Security Preliminary Questionnaire 2021.06.21 (FINAL) Page 1 of 1
To be completed by proposer and email to:
Business Name:
Business Address:
Street/Apt# City /Zip (Postal) Code State / Country Business Contact:
Full Name (Last, First, Middle) Position / Title / Role Phone #
Business Tax ID #:
Federal Tax ID Email Address Provide a brief description of the Product(s) or Service(s) to be provided:
Provide a list of all Officers, Owners, Shareholders (15% or greater), Directors, Members and Partners.
Full Name (Last, First, Middle): Position / Title / Role:
Will subcontractor(s) be used to a substantial degree for the products or services provided to the Oregon Lottery? If YES, please list the subcontractor(s): Yes No
Subcontractor Name: Product / Service: Location (State):
Where will the majority of the work be performed for the Oregon Lottery? Please list.
Type of Work: Address, City, State:
Name of person completing form (Print):
| To be completed by proposer and email to: |
| Bus i ness Name: |
| Bus i ness Address: |
| Provide a brief description of the Products or Services to be providedRow1: |
| Position Title RoleRow5: |
| Full Name Last F rst M dd eRow6: |
| Position Title RoleRow6: |
| Yes: Off |
| No: Off |
| Subcontractor NameRow1: |
| Product ServiceRow1: |
| Locat on StateRow1: |
| Subcontractor NameRow2: |
| Product ServiceRow2: |
| Locat on StateRow2: |
| Subcontractor NameRow3: |
| Product ServiceRow3: |
| Locat on StateRow3: |
| Subcontractor NameRow4: |
| Product ServiceRow4: |
| Locat on StateRow4: |
| Subcontractor NameRow5: |
| Product ServiceRow5: |
| Locat on StateRow5: |
| Type of WorkRow1: |
| Address C ty StateRow1: |
| Type of WorkRow2: |
| Address C ty StateRow2: |
| Type of WorkRow3: |
| Address C ty StateRow3: |
| Type of WorkRow4: |
| Address C ty StateRow4: |
| Name of person comp l et i ng form Pr i nt: |
| Emai Address: |
| Business Contact Full Name: |
| Business Contact Position Title Role: |
| Business Contact Phone #: |
| Business Tax ID: |
| Position Title RoleRow2: |
| Full Name Last F rst M dd eRow3: |
| Position Title RoleRow3: |
| Full Name Last F rst M dd eRow4: |
| Position Title RoleRow4: |
| Full Name Last F rst M dd eRow5: |
| Full Name Last F rst M dd eRow1: |
| Position Title RoleRow1: |
| Full Name Last F rst M dd eRow2: |
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