Contractor_Information_Form__rev._5.24_.pdfContractor_Information_Form__rev._5.24_.pdf
PDF 1 MB Posted
- Solicitation number
- SRC0000037772
- Issued by
- Clermont County, Ohio
About this file
This is a Contractor Information Form (Revision 5/2024) used by the State of Ohio for the Southwest Ohio Developmental Center (SODC) Generator/Transfer Switch Preventive Maintenance solicitation. The form serves as a required submission document that must be completed, signed, and submitted with an RFP proposal to establish contractor eligibility for review and scoring. Contractors are required to provide comprehensive information including their legal business name, street address, city, state, and ZIP code, along with primary contact details for an offeror representative. The form requests current employee counts on both a nationwide and Ohio-specific basis, as well as demographic information regarding the percentage of women and minority employees. Additionally, contractors must identify an authorized signatory with contract execution authority and provide their contact information including name, title, email address, and phone number.
The form requires contractors to disclose their DODD certification status and provide either an OAKS Supplier ID or Tax Identification Number. Contractors must affirm they meet minimum qualifications as identified in Part Two, Section IV of the RFP. The form includes fields for alternate remit-to addresses if different from the mailing address and requires contractors to certify their information under authorized signature with date. This standardized form ensures consistent collection of contractor qualification data and contact information necessary for the procurement evaluation process for preventive maintenance and repair services related to generators and transfer switches at the Southwest Ohio Developmental Center.
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Text version
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 .