Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
Replacing pavilion roofs at Warrensville Developmental Center
Solicitation number
SRC0000029705
Issued by
Cuyahoga County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form designed for submission with a state and local Request for Proposal (RFP). The form requires detailed contractor information, including basic contact details, employee demographics, DODD (Department of Developmental Disabilities) certification status, and OAKS Supplier ID or Tax Identification Number. The form is structured to collect comprehensive information about the contractor's nationwide and Ohio-specific operations, including current employee counts.

The form mandates that contractors provide specific details such as the percentage of women and minority employees, contact information for the person authorized to execute a contract, and a declaration that the contractor meets minimum qualifications outlined in the RFP. The form is marked as revision 5/2024 and appears to be a standard template for potential contractors seeking to participate in a state or local government procurement opportunity, with spaces to enter the specific RFP title and number. Submission of this fully completed and signed form is required for the proposal to be considered eligible for review and scoring.

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Other files

File Type Posted
STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).pdf PDF
RFQ Document pavilion roof.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 .