Contractor_Information_Form__rev._5.24_.pdf

PDF 1 MB Posted

Attached to
GDC FY26 Outdoor Rubber Surfacing Area State and local contract opportunity
Solicitation number
SRC0000036295
Issued by
Gallia County, Ohio

About this file

Written by GovTribe AI ·

This is a Contractor Information Form (Revision 5/2024) required by the State of Ohio for submission with RFP proposals. The form collects essential contractor identification and qualifications data necessary for proposal eligibility and review. Contractors must complete and sign the form to be considered for evaluation and scoring. The form requires contractors to affirm they meet the minimum qualifications identified in Part Two: Section IV of the relevant RFP.

The form requests comprehensive contractor information including business name, address, contact details, current employee counts broken down by nationwide and Ohio-specific operations, and demographic information regarding women and minority employees. Additionally, contractors must provide their OAKS Supplier ID or Tax Identification Number, indicate whether they hold DODD certification, identify the person authorized to execute contracts on behalf of the organization, and supply an alternative remit-to address if different from the mailing address. The form includes checkbox fields for various certifications and requires the authorized signatory's name, title, and email address, along with the date of submission.

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Other files for this state and local contract opportunity

Other files attached to GDC FY26 Outdoor Rubber Surfacing Area, newest first.
File Type Posted
STANDARD_AFFIRMATION_AND_DISCLOSURE_FORM__EO_2019-12D___2022-02D_.pdf PDF
GDC - Rubber Surfacing RFQ.docx DOCX document
Contractor_Certification_Statements.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 .