Contractor_Information_Form__rev._5.24_.pdf

PDF 1 MB Posted

Attached to
FY25 NODC Campus Landscaping State and local contract opportunity
Solicitation number
SRC0000029537
Issued by
Lucas County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form designed for use in a state and local contract opportunity, likely in Ohio. The form requires potential contractors to provide comprehensive details about their organization, including basic contact information, employee demographics, DODD (Department of Developmental Disabilities) certification status, OAKS Supplier ID, and tax identification number. The form is critical for RFP (Request for Proposal) submission and must be completed, signed, and submitted for the proposal to be considered eligible for review and scoring.

The form captures key organizational details such as the current number of employees nationwide and specifically in Ohio, including percentages of women and minorities in the workforce. Contractors must affirm they meet minimum qualifications specified in the RFP and provide contact information for the person authorized to execute a contract. The form also allows for alternative remittance addresses if different from the primary mailing address. Notably, the form is marked with a revision date of 5/2024, indicating it is a recent template for state procurement processes.

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Other files for this state and local contract opportunity

Other files attached to FY25 NODC Campus Landscaping, newest first.
File Type Posted
Contractor_Information_Form__rev._5.24_.pdf PDF
STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D 2022-02D).pdf PDF
NODC_FY25_Campus_Landscaping__Round_2.pdf PDF
Electronic Disclosures and Signatures Consent.pdf PDF
NODC FY25 Campus Landscaping.docx DOCX document

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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 .