Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
WDC Electrical Services Solicitation State and local contract opportunity
Solicitation number
SRC0000029452
Issued by
Cuyahoga County, Ohio

About this file

Written by GovTribe AI ·

The Contractor Information Form is a standardized document for potential contractors to provide company and employee details when responding to a state or local government Request for Proposal (RFP). The form requires contractors to provide basic contact information, confirm meeting minimum qualifications for the specific RFP, indicate DODD (Department of Developmental Disabilities) certification status, provide OAKS Supplier ID or Tax Identification Number, and report employee demographics both nationwide and specific to Ohio operations.

The form also requests additional details such as a remittance address different from the mailing address and contact information for the individual authorized to execute a contract. Key compliance requirements include completing all sections, obtaining an authorized signature, and submitting the form with the RFP proposal to be eligible for review and scoring. The document is marked with a revision date of 5/2024, suggesting it is a current template for state procurement processes, specifically tailored to capture essential contractor information for potential government contract opportunities.

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STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).pdf PDF
WDC Electric RFQ Document (open).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 .