Ex B Contractor Info Fillable.pdf

164 KB Posted

Attached to
Washington State Magazine Advertising Services
Solicitation number
CC0425-JMC
Issued by
Washington

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Exhibit B is a contractor information form required as part of the response submission for Washington State University's advertising services solicitation. The document serves as a standardized template for collecting essential contractor qualification and organizational details from firms interested in providing advertising consulting and sales management services for Washington State Magazine.

The form requires contractors to provide comprehensive organizational information including legal entity name, principal place of business address, telephone contact, business structure, year established, Federal Employer ID, and Washington UBI revenue registration number. Additionally, contractors must submit detailed contact information for their RFP representative, identify all principal officers with their titles and email addresses, and disclose any current or former Washington State employees on staff or the contractor's governing board within the past 24 months, including their agency affiliation, title, and separation date if applicable. The form includes sections for documenting employee relationships with the State of Washington and requires contractors to identify responsibilities of any dual-employed individuals to ensure compliance with state conflict-of-interest regulations.

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Other files

File Type Posted
CC0425-JMC WS Magazine Advertising Services.pdf PDF
7026_Trail TSI_IFB Exhibit B_Part III.pdf PDF
Exhibit C Fee Sheet CC0425-JMC.xlsx XLSX spreadsheet
Ex A Certifications Fillable.pdf PDF
7026_Trail TSI_IFB Exhibit B_Part IV.pdf PDF

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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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