ESBD_516615_1778879002330_Form 10-Entity’s Physical Location(s) Part A (VR 3442A).pdf
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- Solicitation number
- 3202600157
- Issued by
- Texas
About this file
This is a Form 10 document titled "Entity's Physical Location(s) Part A" (VR 3442A) related to a Texas state and local contract opportunity. The form is designed to collect information about an entity's physical locations as part of the bidding or certification process. The document requests detailed information regarding where the entity conducts business operations, including primary and secondary locations, facility addresses, and the nature of operations conducted at each location. This form typically serves as part of a larger application or bid package to establish the entity's operational footprint and geographic presence within Texas.
The form is a standardized template used by Texas procurement agencies to verify that bidding entities have legitimate, established physical locations from which they operate. The information gathered through this form ensures that entities meet location-based requirements, small business certifications, or other geographic preferences that may apply to the contract opportunity. No specific pricing terms, contract duration, or award information is contained within this particular document, as it functions solely as a locational verification component of a broader procurement documentation package.
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Text version
VR3442A (12/22) Entity’s Physical Location Part A – Service Contracts Certification Statement Page 1 of 1
Texas Workforce Commission Vocational Rehabilitation Services
Entity’s Physical Location(s) Part A – Service Contracts Certification Statement
Instructions:
• For response to an Electronic State Business Daily (EBSD) posting, follow the instructions in the
ESBD posting, otherwise submit updated forms to the Quality Assurance Specialist for VR (Q) or Regional Program Support Specialist (RPSS).
• Follow instructions on the form and in the TWC VR Standards for Providers.
• Type all information on form using a computer and get all required signatures.
• Complete all sections of the form. Record “N/A” (not applicable) if a question does not apply.
• Keep a copy of your submitted form with attachments and supporting documentation for your records.
Reason for Submission
Date of submission: Solicitation ID: or Contract #:
Application package
Update of information due to change in information on file. For example, new physical location.
Other: Specify:
Entity’s Information Entity: The business that is requesting or has been granted the bilateral contract with TWC to provide services on behalf of VR customers.
Entity’s legal name:
Entity’s “doing business as” (DBA) name:
Provide at least one of the following:
Employer Identification Number (EIN) (9 digits, issued by IRS):
Last four digits of the sole proprietor’s Social Security Number:
Certification of Entity’s Physical Location Status Physical location: Is a location the contractor owns, leases, or uses as dedicated space to provide goods and/or services to customers and/or attend meetings with customers.
NOTE: Physical locations do not include community sites such as state, federal, city, county, or other public meeting spaces. Contactors that provide all services at community sites that are not owned or leased by the contractor are not required to maintain a physical location.
The entity has one or more physical locations as defined above. Yes No
If yes, a VR3442B MUST be completed for each location.
I, the legally authorized representative, have the authority to certify:
• all inforamtion on this form is true and accurate; and
• the entity acknowledges it must update this form anytime information changes.
Typed name:
Handwritten Signature:
X
Date:
File details come from the government source that posted it. Updated .