Contractor Information Form (rev. 5.24).pdf

1 MB Posted

Attached to
TDC Plumbing Services
Solicitation number
SRC0000029508
Issued by
Seneca County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form, likely for a state government procurement process in Ohio, designed to collect essential details from potential contractors submitting a proposal for a Request for Proposal (RFP). The form requires contractors to provide comprehensive company information, including contact details, 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 provide employee statistics for both nationwide and Ohio-specific operations.

The form is structured to gather critical vendor information for evaluation purposes, with sections dedicated to verifying the contractor's organizational profile, workforce composition, and authorized representatives. Notably, the form requires contractors to disclose the percentage of women and minorities in their workforce, both nationally and within Ohio, and identify a key contact with contract execution authority. The document is marked as revision 5/2024 and emphasizes that the form must be fully completed, signed, and submitted with the RFP proposal to be considered eligible for review and scoring.

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TDC Plumbing RFQ Document (Rnd 2).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 .