Ex A-2 BiddersProfile.docx

271 KB Posted

Attached to
Buy 3 autoclaves and associated services
Solicitation number
K5904
Issued by
Thurston County, Washington

About this file

Written by GovTribe AI ·

This is a Bidder's Profile form (Exhibit A-2) for a Washington State Department of Agriculture (WSDA) contract opportunity. The form is designed to collect comprehensive information from bidders interested in supplying three autoclaves with associated warranty, 24-hour service, regular maintenance, accreditations, deinstallation, and installation services in Thurston County, Washington.

The document requires bidders to provide their legal business information, UBI number, taxpayer identification number, and certification status for minority/women-owned businesses (MWBE), Washington State Small Business, and Veteran-Owned Business classifications. The form also requires three commercial or government references for similar scope projects and designated points of contact for contract management, including an authorized representative and contract administrator. Small business classifications are defined by annual gross revenue thresholds: Microbusiness (less than $1 million), Minibusiness ($1-3 million), and Small Business (less than $7 million for three consecutive years).

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Other files

File Type Posted
K5904 RFQQ am-1.docx DOCX document
K5904 Autoclaves and services.pdf PDF
K5904 Exhibit B - Quals.docx DOCX document
Ex A-1 Bidder Cert.docx DOCX document
K5904 Exhibit C - Pricing.docx DOCX document

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EXHIBIT A-2 – BIDDER’S PROFILE

Competitive Solicitation:
No.

Project Title

Bidder:
___________________________

Type/print full legal name of Bidder

BIDDER INFORMATION

Legal name of Bidder:

Address of Bidder:

Note: This information must match the information from Bidder’s Business License.

Business Name Address City, State, Zip Code

Bidder’s Washington State Department of Revenue Registration Number/Unified Business Identifier (UBI) Number:

Note: A nine digit UBI number is assigned to each registered businesses in Washington.

Taxpayer Identification No. (TIN):

Note: Your TIN will be either a number issued by the IRS (e.g., Employer Identification Number, Federal Tax Identification Number) or a number issued by the Social Security Administration (i.e., your Social Security Number). Do Not provide a Social Security Number.

Is your firm certified as a minority or woman owned business with the Washington State Office of Minority & Women’s Business Enterprises (OMWBE)?
Yes |_| No |_|

If yes, provide Bidder’s MWBE certification no.: ____________

Is your firm a self-certified Washington State Small Business?

Note: See Exhibit A-1 – Bidder’s Certification for criteria to qualify as a Washington State Small Business.

Note: Regardless of size, a qualifying business must be owned and operated independently from all other businesses. In regard to size, the gross revenue thresholds, as reported on Bidder’s tax returns, are as follows:

· Microbusiness: Annual gross revenue of less than one million dollars.

· Minibusiness: Annual gross revenue of more than one million dollars, but less than three million dollars.

· Small Business: Annual gross revenue of less than seven million dollars over each of the three prior consecutive years.

Yes |_| No |_| If yes, provide the location for Bidder’s principal place of business:

Street Address City, State, Zip Code If yes, what is your business size (based on annual gross revenue)?

Microbusiness|_|
Minibusiness|_|
Small Business|_|

Is your firm certified as a Veteran-Owned Business with the Washington State Department of Veteran Affairs?

Note: See Exhibit A-1 – Bidder’s Certification for criteria to qualify as a Certified Veteran-Owned Business.

Yes |_| No |_| If yes, provide Bidder’s WDVA certification no.: _____________

CONTRACT MANAGEMENT POINTS OF CONTACT FOR BIDDER

Authorized Representative Name:

Email:

Phone:

Contract Administrator Name:

Email:

Phone:

Address for Enterprise Services to send legal notices:

Company name:

Attn:

Address:

City/State/Zip:

Signature Authority (if awarded a contract) Name:

Title:

REFERENCES

Provide a minimum of three (3) commercial or government references for which bidder has delivered goods and/or services similar in scope as described in the Competitive Solicitation.

REFERENCE 1

Company Name:

Contact:

Phone:

Email:

REFERENCE 2

Company Name:

Contact:

Phone:

Email:

REFERENCE 3

Company Name:

Contact:

Phone:

Email:

Return this Bidder’s Profile to Procurement Coordinator at:

aschreib@centurytel.net

EXHIBIT A-2 – BIDDER’S PROFILE: K5904 PAGE 1

(Rev 2023-05-15) image1.jpeg

File details come from the government source that posted it. Updated .