Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
SODC Commercial Electric Double Convection Oven
Solicitation number
SRC0000027479
Issued by
Clermont County, Ohio

About this file

Written by GovTribe AI ·

This is a Contractor Information Form (revision 5/2024) used for submitting proposals in response to an RFP in Ohio. The form requires basic contractor information including business name, address, contact details, and DODD provider certification status if applicable. Contractors must affirm they meet minimum qualifications identified in Part Two: Section IV of the RFP (specific RFP title and number to be entered by contractor).

The form requires contractors to provide their OAKS Supplier ID or Tax Identification Number, current employee information both nationwide and for Ohio operations (including total employees, percentage of women, and percentage of minorities), alternate remit-to address if applicable, and contact information for the person authorized to execute contracts. The form must be completed, signed, and submitted with the RFP proposal to be considered eligible for review and scoring. No specific pricing terms, set-asides, or funding requirements are included in this standard information collection form.

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File Type Posted
STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).pdf PDF
SODC-Electric Double Convection Oven.pdf PDF

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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 .