Contractor Information Form.docx
DOCX document 24 KB Posted
- Attached to
- Funeral Service
- Solicitation number
- SRC0000026146
- Issued by
- Erie County, Ohio
About this file
This is a Contractor Information Form from Ohio. The form requests basic business contact information including contractor name, address, and authorized contact details. It also requires specific workforce demographic data, requesting employee counts and percentages of women and minorities both nationwide and specifically for Ohio operations.
The form requires the contractor's OAKS Supplier ID or Tax Identification Number and provides space for an alternate billing address if different from the mailing address. The document appears to be a standard government contractor registration form that must be signed and dated by an authorized representative.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment A - Funeral Services - SOW.docx | DOCX document | |
| Certification Statement.docx | DOCX document | |
| Terms and Conditions.pdf | ||
| Affirmation_and_Disclosure_Form_5-20-24_fillable_form.pdf | ||
| Business Associate Agreement.pdf |
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Text version
CONTRACTOR INFORMATION FORM
| CONTRACTOR NAME: _ _ _ _ _ _ _ _ |
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| STREET ADDRESS: _ _ _ _ _ _ _ _ _ |
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| CITY: _ _ _ _ | _ _ _ _ _ _ _ _ |
| STATE: _ | |
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| ZIP CODE: _ | |
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| AUTHORIZED CONTACT NAME: _ _ _ _ |
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| PHONE NUMBER: _ _ _ _ _ _ _ _ _ |
| EMAIL: _ |
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1. Provide current employee informat ion on both a nationwide basis (including Ohio), and Ohio's based operations.
NATIONWIDE OHIO
Total # of Employees: Percent of Women: Percent of Minorities:
2. Provide OAKS Supplier ID or Tax Identification Number: _ _ _ _ _ _ _ _ _ _ _
3. If your billing address is different than mailing address above, please provide below:
Contractor Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Street Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Cit_y: _ _ _ _ _ _ _ _ _ _ _ _ _ _ State: _ _ _ _ _ Zip Code: _ _ _ _
Authorized Signature Date
File details come from the government source that posted it. Updated .