Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
NODC Electrical Services Solicitation State and local contract opportunity
Solicitation number
SRC0000029437
Issued by
Ohio

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The document is a Contractor Information Form designed for a state and local contract opportunity, specifically a request for proposal (RFP) submission. The form requires potential contractors to provide comprehensive details about their organization, including basic contact information, employee demographics, DODD certification status, and OAKS Supplier ID or Tax Identification Number. Contractors must affirm they meet minimum qualifications specified in Part Two, Section IV of the RFP, and the form must be completed, signed, and submitted with the RFP proposal to be considered eligible for review and scoring.

The form captures critical organizational details such as the current number of employees both nationwide and specific to Ohio operations, including percentages of women and minority employees. It also solicits information about the remittance address if different from the mailing address and requires contact details for the person authorized to execute a contract on behalf of the contractor. The form is marked with a revision date of 5/2024, indicating it is a recent template for potential state or local government contract opportunities, with an emphasis on capturing comprehensive vendor information for evaluation purposes.

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NODC Electric RFQ Document (open).docx DOCX document
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 .