Contractor_Information_Form__rev._5.24_.pdf

PDF 1 MB Posted

Attached to
TDC sidewalks
Solicitation number
SRC0000027234
Issued by
Seneca County, Ohio

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This is a Contractor Information Form required for RFP submissions, with a revision date of 5/2024. The form collects essential contractor details including business name, address, contact information, and DODD certification status. It requires contractors to affirm they meet minimum qualifications identified in Part Two: Section IV of the associated RFP.

The form requires specific data regarding employee demographics both nationwide and for Ohio operations, including total employee count, percentage of women, and percentage of minorities. It also requests the contractor's OAKS Supplier ID or Tax Identification Number, alternate remittance address if applicable, and contact information for the person authorized to execute contracts. The form must be completed, signed, and submitted with the RFP proposal to be considered eligible for review and scoring.

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File Type Posted
SIDEWALK RFQ.docx DOCX document
STANDARD_AFFIRMATION_AND_DISCLOSURE_FORM__EO_2019-12D___2022-02D_ (1).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 .