Contractor_Information_Form__rev._5.24_.pdf

PDF 1 MB Posted

Attached to
FY25 NODC Air Handler, Building 601 State and local contract opportunity
Solicitation number
SRC0000029535
Issued by
Lucas County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form designed for a state and local contract opportunity, likely in Ohio. The form requires potential contractors to provide comprehensive company details, including contact information, employee demographics, DODD (Department of Developmental Disabilities) certification status, and OAKS Supplier ID or Tax Identification Number. The form is part of a Request for Proposal (RFP) process, with contractors required to affirm they meet minimum qualifications specified in Part Two, Section IV of the RFP.

The form captures critical organizational data, including current employee counts (both nationwide and in Ohio), percentage of women and minority employees, and contact information for the individual authorized to execute the contract. Contractors must complete and sign this form to be eligible for review and scoring in the RFP process. The form is marked with a revision date of 5/2024, indicating it is a current template for potential government contractors seeking to participate in a state-level procurement opportunity.

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Other files for this state and local contract opportunity

Other files attached to FY25 NODC Air Handler, Building 601, 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_Air_Handler_601__Round_2.pdf PDF
Electronic Disclosures and Signatures Consent.pdf PDF
NODC FY25 Air Handler 601.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 .