Contractor_Information_Form__rev._5.24_.pdf

PDF 1 MB Posted

Attached to
SODC Commercial Dishwasher High Temperature State and local contract opportunity
Solicitation number
SRC0000037047
Issued by
Ohio

About this file

Written by GovTribe AI ·

This is a Contractor Information Form (Rev. 5/2024) for the State of Ohio related to a solicitation for one Commercial Dishwasher High Temperature. The form must be completed, signed, and submitted with the RFP proposal to be considered eligible for review and scoring. Contractors must affirm that they meet the minimum qualifications identified in Part Two: Section IV of the RFP. The form requests the contractor to provide current employee information on both a nationwide and Ohio-specific basis, including the number of employees and the percentage of women and minorities employed. Additionally, contractors must supply their OAKS Supplier ID or Tax Identification Number, contact information for the offeror and authorized contract signatory, and their remit-to address if different from the mailing address.

The form includes sections for DODD certification verification and requires contractors to identify whether they hold current DODD provider certification. Contractors must designate an authorized contact person with authority to execute a contract on behalf of the organization, including that individual's name, title, email address, phone number, and mailing address. The form requires signature and date authentication from an authorized representative to validate that the contractor meets all minimum qualifications before the proposal can advance to the review and scoring process.

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STANDARD_AFFIRMATION_AND_DISCLOSURE_FORM__EO_2019-12D___2022-02D_.pdf PDF
SODC- Commercial High Temperature Dishwasher.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 .