Contractor Information Form (rev. 5.24).pdf

PDF 1 MB Posted

Attached to
GDC Plumbing Services
Solicitation number
SRC0000029496
Issued by
Gallia County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form (Revision 5/2024) used for submitting proposal details for a state and local contract opportunity. 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 the Request for Proposal (RFP) and provide employee information for both nationwide and Ohio-specific operations.

The form is designed to collect critical vendor information for potential contract award, including diversity metrics (percentage of women and minorities in the workforce), remittance address details, and contact information for the individual authorized to execute the contract. Submission of this completed and signed form is mandatory for a proposal to be considered eligible for review and scoring. The form appears to be part of a standardized procurement process, likely for a state of Ohio government contract, with specific requirements for vendor qualification and representation.

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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 .