Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
Legionella and Water Quality Testing
Solicitation number
SRC0000023802
Issued by
Greene County, Ohio

About this file

Written by GovTribe AI ·

This document is a Contractor Information Form for a state and local government contract opportunity. It requires contractors to provide details about their company, including the number of employees, percentage of women and minorities, DODD certification status, OAKS supplier ID, and contact information for the authorized signatory. The form must be completed, signed, and submitted with the contractor's proposal in order for it to be considered eligible for review and scoring. The contract opportunity is referenced by RFP title and number, but no additional details about the scope of work, due dates, or contract term are provided in this document.

The form also requests information about the contractor's nationwide and Ohio-specific employee counts. Contractors must provide a remittance address if it differs from the mailing address. The document emphasizes that the authorized signatory contact information is required. No other pricing, set-aside, incumbent, or funding details are included in this Contractor Information Form.

View the file

Other files

File Type Posted
Legionella RFQ Document.docx DOCX document
STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).pdf PDF

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

CONTRACTOR INFORMATION FORM

STATE: ZIP CODE:

CONTRACTOR NAME:

STREET ADDRESS:

CITY:

OFFEROR CONTACT NAME:

PHONE NUMBER: EMAIL:

Current number of employees:

Percent of Women:

Percent of Minorities:

Authorized Signature Date

Contractor affirms that they meet the minimum qualifications identified in Part Two: Section IV of the RFP title:

This form must be completed, signed, and submitted with RFP Proposal for it to be considered eligible for review and scoring. Rev. 5/2024

1. DODD certified provider? NO YES, DODD Provider Certification #

2. Provide OAKS Supplier ID or Tax Identification Number:

3. Current employee information on both a nationwide basis (including Ohio), and for Ohio operations.

(enter RFP Title and RFP Number beginning with SRC)

Nationwide Ohio

4. If your remit to address is different than the mailing address above, pleas provide below:

Street Address:

City: State: Zip Code:

5. Provide contact information for person with authority to execute a contract on behalf of the contractor.

Name: Title:

Email:

Krista Shaw Line

Krista Shaw Line

Krista Shaw Line

STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
PHONE NUMBER:
EMAIL:
NATIONWIDE 1:
NATIONWIDE 2:
NATIONWIDE 3:
OHIO 1:
Provide OAKS Supplier ID or Tax Identification Number:
Street Address:
Zip Code:
Date:
Check Box1: Off
CONTRACTOR NAME:
RFP Name & SRC #:
OHIO 2:
OHIO 3:
City:
State:
AUTHORIZED CONTACT NAME:
Signatory Name:
Signatory Title:
Signatory Email:
Check Box2: Off
Check Box3: Off
Certification #:

File details come from the government source that posted it. Updated .