Contractor_Information_Form__rev._5.24_.pdf

1 MB Posted

Attached to
TDC Garza Automatic Doors
Solicitation number
SRC0000025813
Issued by
Seneca County, Ohio

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Written by GovTribe AI ·

This document is a Contractor Information Form related to a state contract opportunity. The form requires the contractor to provide their company information, including their name, address, contact details, and employee demographics such as the percentage of women and minorities. The contractor must also indicate whether they are a certified provider with the Ohio Department of Developmental Disabilities (DODD) and provide their OAKS Supplier ID or Tax Identification Number. The form must be completed, signed, and submitted with the Request for Proposal (RFP) proposal for the contractor to be considered eligible for review and scoring.

The document does not provide details about the specific products or services requested, project overviews, item quantities, response dates, due dates, site visits, bidder's meetings and conferences, award dates, or the term of the contract. It also does not include information about pricing terms, set asides, incumbents, current environment, funding requirements and sources, or any other salient details.

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File Type Posted
TDC AUTOMATIC DOORS RFQ_Document__002_ (1).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 .