Contractor_Information_Form__rev._5.24_.pdfContractor_Information_Form__rev._5.24_.pdf
PDF 1 MB Posted
- Solicitation number
- SRC0000041726
- Issued by
- Cuyahoga County, Ohio
About this file
This is a Contractor Information Form for the State of Ohio related to a Warrensville Developmental Center Generator/Transfer Switch Preventive Maintenance contract opportunity. The form requires contractors to provide comprehensive business information including company name, mailing address, contact details, and authorized signatory information. Contractors must disclose current employee counts both nationally and specifically for Ohio operations, along with demographic data regarding women and minority representation. The form requires submission of either an OAKS Supplier ID or Tax Identification Number, and contractors must affirm DODD certification status if applicable. All sections must be completed, signed, and submitted with the RFP proposal for the contractor to be considered eligible for review and scoring.
The form does not contain pricing information, set-asides, or contract term details in its content. Instead, it functions as a qualification and eligibility verification document requiring contractors to confirm they meet the minimum qualifications identified in Part Two: Section IV of the referenced RFP. The form was revised in May 2024 and serves as a mandatory administrative requirement for any entity seeking to bid on the Warrensville Developmental Center generator and transfer switch testing, inspection, preventive maintenance, and repair services contract. Contractors must provide contact information for the person with authority to execute contracts on behalf of the organization, ensuring proper authorization for contractual obligations.
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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 .