Contractor Information Form (rev. 5.24).pdf

1 MB Posted

Attached to
TDC FY26 Campus Wide Fencing
Solicitation number
SRC0000036262
Issued by
Shelby County, Ohio

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This document is a Contractor Information Form (Revision 5.24) issued by the State of Ohio for use in response to state and local Request for Proposal (RFP) solicitations. The form serves as a mandatory submission requirement for all offerors and must be completed, signed, and submitted with an RFP proposal to be considered eligible for review and scoring. The form collects essential contractor identification and operational data, including the contractor's legal name, street address, city, state, and ZIP code, along with designated offeror contact information consisting of a contact name, phone number, and email address. Additionally, the form requires contractors to provide current employee counts on both a nationwide and Ohio-specific basis, along with demographic information regarding the percentage of women and minority employees. The document also requests information regarding an authorized signatory with contract execution authority, including the signatory's name, title, email, and contact details.

The form includes additional compliance and identification requirements, such as confirmation of whether the contractor holds Department of Developmental Disabilities (DODD) certification status with associated certification numbers if applicable, and submission of either an OAKS Supplier ID or Tax Identification Number. Contractors are required to provide their remit-to address if it differs from the primary mailing address listed on the form. The form does not address specific pricing terms, set-asides, incumbent information, funding amounts, or contract term details, as it functions as an administrative data collection instrument rather than a substantive solicitation document. The document is standardized for use across multiple RFP opportunities within the State of Ohio procurement process.

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Other files

File Type Posted
Contractor Certification Statements.pdf PDF
STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).pdf PDF
TDC Campus Fencing RFQ Document.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 .