Contractor_Information_Form__rev._5.24_.pdf

PDF 1 MB Posted

Attached to
FY25 NODC Air Handler, Building 601 State and local contract opportunity
Solicitation number
SRC0000029535
Issued by
Lucas County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form issued by the state of Ohio, specifically for a state and local contract opportunity related to the Northwest Ohio Development Center (NODC). The form is designed for contractors interested in replacing an air handler in Building 601 for fiscal year 2025, with proposals due by April 18, 2025. The form requires detailed information from potential contractors, including company contact details, employee demographics, DODD certification status, OAKS Supplier ID, and current employee information both nationwide and specific to Ohio operations.

The form serves as a critical procurement document that mandates contractors affirm they meet minimum qualifications specified in the Request for Proposal (RFP). Contractors must provide their current number of employees, percentage of women and minorities in their workforce, and contact information for the person authorized to execute the contract. The document emphasizes compliance and transparency, requiring a signature, date, and comprehensive company information to be considered eligible for review and scoring. While specific budget details are not included in this form, it represents a key step in the procurement process for the NODC's building infrastructure improvement project.

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Other files for this state and local contract opportunity

Other files attached to FY25 NODC Air Handler, Building 601, newest first.
File Type Posted
NODC_FY25_Air_Handler_601__Round_2.pdf PDF
STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D 2022-02D).pdf PDF
NODC FY25 Air Handler 601.docx DOCX document
Electronic Disclosures and Signatures Consent.pdf PDF
Contractor_Information_Form__rev._5.24_.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 .