Ex. A-2 Contractor's Profile and Refs.pdf
PDF 175 KB Posted
- Solicitation number
- RFQQ 25-11
- Issued by
- Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington
About this file
Exhibit A-2 is a Contractor's Profile and References form for the Washington State Office of the Secretary of State's Request for Qualifications & Quotation (RFQQ) No. 25-11 for Micrographic Services Microfilm Processing and Duplicating Services, issued on March 10, 2025. The document requires potential contractors to provide comprehensive details about their business, including legal name, address, Unified Business Identifier (UBI) number, Taxpayer Identification Number (TIN), and certification status for minority-owned, women-owned, veteran-owned, and small business categories.
The form solicits up to five professional references and allows for listing authorized subcontractors, with provisions for detailing each subcontractor's legal name, disadvantaged status, point of contact, phone number, and email address. Contractors must self-certify their business size based on annual gross revenue, with categories including microbusiness (less than $1,000,000), minibusiness ($1,000,000 to $3,000,000), and small business (less than $7,000,000 over three consecutive years). The completed form is to be returned to the RFQQ Coordinator at Madilyn.Graversen@sos.wa.gov, indicating the state's structured approach to vendor qualification and selection for specialized micrographic services.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Ex. D Box Label Template - Example.pdf | ||
| Ex. C WA Microfilm Standards.pdf | ||
| RFQQ 25-11 Micrographic Services.pdf | ||
| Ex. B Contract Template.pdf | ||
| Ex. A-1 Contractor's Certif.pdf |
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Text version
EXHIBIT A-2 – CONTRACTOR’S PROFILE & REFERENCES: RFQQ No. 25-11
EXHIBIT A-2 – CONTRACTOR’S PROFILE & REFERENCES
Competitive Solicitation: RFQQ No. 25-11 issued March 10, 2025
CONTRACTOR’S INFORMATION PROFILE
Contractor: ___________________________ Type/print full legal name of Contractor
Contractor’s Address:
Business Name
Address
City, State, Zip Code
Contractor’s Unified Business Identifier Number (UBI):
Note: A nine digit UBI number is assigned to each registered business in Washington.
UBI No. ___ ___ ___
Contractor’s Taxpayer Identification Number (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 and Women’s Business Enterprises (OMWBE)?
Yes No
If yes, provide Contractor’s MWBE certification no.:
Is your firm a self-certified Washington State Small Business?
Note: See Exhibit A-1 – Contractor’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 Contractor’s tax returns, are as follows:
▪ Microbusiness: Annual gross revenue of less than $1,000,000
▪ Minibusiness: Annual gross revenue of more than $1,000,000, but less than $3,000,000
▪ Small Business: Annual gross revenue of less than $7,000,000 over each of the three prior consecutive years.
If yes, provide the location for Contractor’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 – Contractor’s Certification for criteria to qualify as a
Certified Veteran-Owned Business.
If yes, provide Contractor’s WDVA certification no.:
CONTRACTOR’S PRIMARY POINTS OF
CONTACT:
Authorized Representative:
Name:
Email:
Phone:
Contract Administrator:
Name:
Phone:
REFERENCES
Provide at least three (3) references for Contractor including company name, contact name, title, phone number, email address, and a description of the work engagement upon which the reference is based.
CONTRACTOR REFERENCES
Company Name:
Contact Name:
Title:
Phone:
Description of Work Engagement:
Company Name:
Contact Name:
Title:
Phone:
Title:
Phone:
Title:
Phone:
Email:
Description of Work Engagement:
Company Name:
Contact Name:
Title:
Phone:
SUBCONTRACTORS
Identify authorized subcontractors who will provide service on a contract resulting from this solicitation.
LEGAL NAME SMALL, WOMEN
OWNED, VETERAN OR
OTHER
DISADVANTAGED
STATUS
POINT OF CONTACT
NAME
PHONE NUMBER EMAIL ADDRESS
Return this Contractor’s Profile & References to the RFQQ Coordinator at:
Madilyn.Graversen@sos.wa.gov
File details come from the government source that posted it. Updated .