Ex B Contractor Info Fillable.pdf

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Attached to
Drayage and Decor WPR Conference 2026 Spokane WA
Solicitation number
CC0017B-JMC
Issued by
Spokane County, Tacoma City, Spokane City, Spokane Valley City, Washington

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This document is an Exhibit B Contractor Information form from Washington State University Procurement and Contract Services, designed to be submitted with a response for a contract opportunity. The form provides a comprehensive template for potential contractors to supply detailed organizational information, including basic company details, business structure, contact information, principal officers, and specific disclosures regarding past or current employment relationships with the State of Washington.

The form requires contractors to provide key identifying information such as legal business name, principal place of business, business structure, year established, federal employer ID, Washington UBI number, and RFP contact details. Additionally, the form mandates transparency about any current or former state employees who may be associated with the contractor, either through recent employment, current positions within the organization, or serving on the governing board. This approach ensures thorough disclosure and helps prevent potential conflicts of interest in the procurement process.

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EXHIBIT B – CONTRACTOR INFORMATION

to be submitted with Response

CONTRACTOR (LEGAL NAME OF ENTITY)

ADDRESS FOR THE PRINCIPLE PLACE OF BUSINESS

CITY, STATE, ZIP:

TELEPHONE

STRUCTURE (CORPORATION, PARTNERSHIP, SOLE PROPRIETORSHIP, ETC.)

YEAR ESTABLISHED

FEDERAL EMPLOYER ID

WASHINGTON UBI (REVENUE REGISTRATION NUMBER)

NAME, TITLE, ADDRESS, EMAIL, PHONE, AND FAX NUMBERS FOR CONTRACTOR’S RFP CONTACT.

NAME AND TITLE

ADDRESS:

CITY, STATE, ZIP

PHONE:

FAX:

E-MAIL

PRINCIPLE OFFICERS (E.G.: PRESIDENT, VICE PRESIDENT, TREASURER, BOARD CHAIRPERSON)

NAME TITLE EMAIL ADDRESS

CONTRACTOR'S EMPLOYEE RELATIONSHIP TO STATE OF WASHINGTON

If the Contractor or any party named above was, or is, an employee of WA State during the past 24 months, the following information is required: If none, indicate “not applicable”.

NAME AGENCY TITLE SEPARATION DATE

PERSONS EMPLOYED BOTH BY CONTRACTOR AND STATE OF WASHINGTON

Contractors employing or having on their governing board as of the date of their proposal, WA State employees, or former WA State employees, shall identify such persons and their position and responsibilities within the Contractor’s organization. If none, indicate “not applicable”.

NAME AGENCY TITLE SEPARATION DATE (OR N/A)

Responsibilities:

Responsibilities:

Solicitation No. WSU
to be submitted with Response
Name, title, address, email, phone, and fax numbers for contractor’s RFP contact.
Contractor's Employee Relationship to State of Washington
Persons Employed Both by Contractor and State of Washington
CONTRACTOR LEGAL NAME OF ENTITY:
ADDRESS FOR THE PRINCIPLE PLACE OF BUSINESS:
CITY STATE ZIP:
TELEPHONE:
STRUCTURE CORPORATION PARTNERSHIP SOLE PROPRIETORSHIP ETC:
YEAR ESTABLISHED:
FEDERAL EMPLOYER ID:
WASHINGTON UBI REVENUE REGISTRATION NUMBER:
NAME AND TITLE:
ADDRESS:
CITY STATE ZIP_2:
PHONE:
FAX:
EMAIL:
NAMERow1:
TITLERow1:
EMAIL ADDRESSRow1:
NAMERow2:
TITLERow2:
EMAIL ADDRESSRow2:
NAMERow3:
TITLERow3:
EMAIL ADDRESSRow3:
NAMERow4:
TITLERow4:
EMAIL ADDRESSRow4:
NAMERow1_2:
AGENCYRow1:
TITLERow1_2:
SEPARATION DATERow1:
NAMERow1_3:
AGENCYRow1_2:
TITLERow1_3:
SEPARATION DATE OR NARow1:
Responsibilities:
Name_Row_2:
Agency_Row2:
Title_Row2:
Separation_Date_or_N/A:
Responsibilities_2:

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