Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
TDC Electrical Services Solicitation State and local contract opportunity
Solicitation number
SRC0000029446
Issued by
Seneca County, Ohio

About this file

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The document is a Contractor Information Form for a state and local contract opportunity, designed to collect comprehensive details from potential contractors. The form requires bidders to provide company contact information, DODD certification status, OAKS Supplier ID or Tax Identification Number, and current employee demographics both nationwide and specific to Ohio operations. The form must be completed, signed, and submitted with the Request for Proposal (RFP) to be considered eligible for review and scoring.

The form captures critical vendor details, including the current number of employees, percentage of women and minorities in the workforce, alternate remittance addresses, and contact information for the individual authorized to execute a contract. Contractors must affirm they meet minimum qualifications specified in the RFP and provide certification details. The form is part of a standardized procurement process, revised in May 2024, that aims to collect uniform information from potential service providers or suppliers for a state-level contracting opportunity.

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STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).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 .