Contractor_Information_Form__rev._5.24_.pdf

1 MB Posted

Attached to
TDC Exterior Painting
Solicitation number
SRC0000027192
Issued by
Seneca County, Ohio

About this file

Written by GovTribe AI ·

This is a Contractor Information Form template dated May 2024, which appears to be associated with an Ohio state contract opportunity requiring DODD (Department of Developmental Disabilities) certification. The form serves as a mandatory submission document that must be completed, signed, and included with an RFP proposal to be considered eligible for review and scoring.

The form requests comprehensive business details including contractor name, contact information, OAKS Supplier ID or Tax Identification Number, and employee demographics both nationwide and specific to Ohio operations (including percentages of women and minorities employed). The form also requires contractors to affirm they meet minimum qualifications from Part Two: Section IV of the associated RFP, provide DODD certification status if applicable, and include information for an authorized contract signatory. A separate remittance address can be specified if different from the primary business address.

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Other files

File Type Posted
TDC Exterior Painting 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 .