Contractor_Information_Form__rev._5.24_.pdf

PDF 1 MB Posted

Attached to
SODC Commercial Electric Steam Kettle 6 Gallon
Solicitation number
SRC0000037029
Issued by
Ohio

About this file

Written by GovTribe AI ·

This is a Contractor Information Form for the State of Ohio related to a solicitation for one commercial-grade electric 6-gallon steam kettle. The form serves as a pre-qualification and eligibility document that must be completed, signed, and submitted with the proposal to be considered for review and scoring. The contractor must affirm that they meet the minimum qualifications identified in Part Two: Section IV of the relevant Request for Proposal (RFP).

The form requires submission of essential contractor information including business name, street address, city, state, zip code, offeror contact name, phone number, and email address. Additionally, contractors must provide current employee information on both a nationwide basis and specifically for Ohio operations, indicate whether they are a DODD-certified provider with certification number if applicable, supply either an OAKS Supplier ID or Tax Identification Number, and disclose the current percentage of women and minorities among their workforce. Contractors must also designate a contact person with authority to execute contracts on behalf of the organization, provide a remit-to address if different from the mailing address, and include the signature of an authorized representative with the date of execution. All required fields and checkboxes must be completed for the submission to be deemed eligible for consideration.

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Other files

File Type Posted
STANDARD_AFFIRMATION_AND_DISCLOSURE_FORM__EO_2019-12D___2022-02D_.pdf PDF
SODC- Steam Kettle 6 Gallons.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 .