Contractor_Information_Form__rev._5.24_.pdf

1 MB Posted

Attached to
TDC fence Garza 2 & 3
Solicitation number
SRC0000031435
Issued by
Seneca County, Ohio

About this file

Written by GovTribe AI ·

The document is a Contractor Information Form, likely associated with a state government procurement process in Ohio. The form is designed to collect comprehensive details from potential contractors seeking to bid on a state contract, with a revision date of May 2024. The form requires contractors to provide company details, employee demographics, DODD certification status, OAKS Supplier ID, and contact information for the individual authorized to execute the contract.

The form seeks specific information including the current number of employees nationwide and within Ohio, with breakdowns of women and minority percentages. Contractors must affirm they meet minimum qualifications specified in the Request for Proposal (RFP), and provide their contact details, remittance address, and certification information. The form emphasizes that it must be fully completed, signed, and submitted with the RFP proposal to be considered eligible for review and scoring, indicating a structured and formal procurement process with specific compliance requirements.

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File Type Posted
STANDARD_AFFIRMATION_AND_DISCLOSURE_FORM__EO_2019-12D___2022-02D_ (1).pdf PDF
TDC FENCE GARZA 2 and 3.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 .