Contractor Information Form (rev. 5.24).pdfContractor Information Form (rev. 5.24).pdf
PDF 1 MB Posted
- Attached to
- NODC Roll-Up Counter Shutter Replacement
- Solicitation number
- SRC0000042163
- Issued by
- Lucas County, Ohio
About this file
This Contractor Information Form is related to a solicitation issued by the Ohio Department of Developmental Disabilities for roll-up counter shutter replacement services at Northwest Ohio Developmental Center in Toledo. The scope of work includes turnkey removal and disposal of the existing roll-up counter shutter located in building 610's canteen, along with furnishing and installation of one Wayne Dalton Rolling Counter Door, Model CFS-510, measuring 11'9" x 3'8" with nonrated, clear anodized aluminum flat slats, hand-crank manual operation, and pad-lockable slide bolt locking on both ends. A mandatory site visit is scheduled for October 6, 2026 at 10:00 a.m. at the administration building #612. Quotations are due October 16, 2026 at 2:00 p.m., with an inquiry period closing October 13, 2026 at 2:00 p.m. The contract term runs from an estimated October 19, 2026 through June 30, 2027. All installation work must be completed on consecutive days between 7:00 a.m. and 3:30 p.m., Monday through Friday.
Bidders must be regularly engaged in shutter installation and maintain all necessary licenses, certifications, and registrations, with all personnel required to pass criminal background checks and comply with Section 5123.08 of the Ohio Revised Code. Prevailing wage requirements apply if the project exceeds Ohio Department of Commerce thresholds. Quotations must include all parts, labor, permits, and associated engineering services. The contract will be awarded to the lowest responsive and responsible bidder. Bidders may claim preferences under Ohio Revised Code 125.11 (Domestic Preference), Ohio Revised Code 125.09 (Ohio Preference with significant economic presence, tax payment, and employee-threshold requirements), or Ohio Revised Code 9.318 (Veteran Friendly Business Enterprise status), and must complete the corresponding Contractor Certification Statement to qualify for any claimed preference.
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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 #: |
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