Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
SODC Concrete Project State and local contract opportunity
Solicitation number
SRC0000029934
Issued by
Clermont County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form, likely used for a state procurement process in Ohio, designed to collect comprehensive details from potential contractors submitting a proposal for a Request for Proposal (RFP). The form requires contractors to provide basic company information, including contact details, employee demographics, DODD (Department of Developmental Disabilities) certification status, OAKS Supplier ID or Tax Identification Number, and employee statistics for both nationwide and Ohio-specific operations.

The form serves as a critical component of the proposal submission process, mandating that contractors affirm they meet minimum qualifications specified in the RFP's Part Two: Section IV. Key requirements include documenting the current number of employees, percentages of women and minorities in the workforce, and providing contact information for the person authorized to execute a contract. The form must be fully completed, signed, and submitted with the RFP proposal to be considered eligible for review and scoring, with a revision date of May 2024 indicating it is a current procurement document.

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Other files for this state and local contract opportunity

Other files attached to SODC Concrete Project, newest first.
File Type Posted
STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).pdf PDF
RFQ# SODC-Concrete Project.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 .