Exhibit A-2-Bidders Profile.docx
DOCX document 281 KB Posted
- Attached to
- STORMWATER TESTING SERVICES
- Solicitation number
- RFQQ-2024-0911
About this file
This document is a Bidder's Profile form for a competitive solicitation (RFQQ 2024 0911) issued by the Washington State Department of Transportation (WSDOT) for stormwater testing services. The solicitation seeks to establish a contract for statewide sampling for National Pollutant Discharge Elimination System (NPDES) stormwater monitoring, water quality assessment, research, and project support purposes. The contract will cover service locations throughout the state, including jurisdictions such as Fort Lewis CDP, King County, North Fort Lewis CDP, Lewis County, Mason County, Thurston County, Pierce County, Kingston CDP, and Lewisville CDP.
The form requires bidders to provide their legal name, address, Washington State Department of Revenue registration number, taxpayer identification number, and indicate whether they intend to utilize subcontractors. Bidders must also indicate if they are certified as a minority or woman-owned business, a self-certified Washington State small business, or a certified veteran-owned business. The form also requests contact information for the authorized representative, contract administrator, and ordering/sales points of contact, as well as references and service locations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit B-Performance Requirements.docx | DOCX document | |
| Exhibit D-1-Contract Issues List.docx | DOCX document | |
| Exhibit G- Scope of Work.pdf | ||
| RFQQ 2024 0911 Competitive Solicitation.pdf | ||
| Exhibit A-1-Bidders Certification.docx | DOCX document | |
| Exhibit C-Bid Price.docx | DOCX document | |
| Exhibit E-Diverse Business Inclusion Plan.docx | DOCX document | |
| Pre-Bid_RFQQ 2024 0911- Stormwater Testing.pdf | ||
| RFQQ 2024 0911_QA Document.pdf | ||
| Exhibit D-Contract.pdf | ||
| Exhibit F-Reference Form.docx | DOCX document |
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Text version
EXHIBIT A-2 – BIDDER’S PROFILE
| Competitive Solicitation: |
| No. RFQQ 2024 0911 |
| 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.
Does Bidder intent to utilize subcontractors to perform the Contract, if awarded?
Note: If Bidder intends to utilize subcontractors, Bidder must identify Bidder’s intended subcontractors.
Yes |_| No |_| If yes, provide Bidder’s anticipated subcontractor(s): ____________
| 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:
Email: ________________
Signature Authority (if awarded a contract) Name:
Title:
Email: ________________
ORDERING/SALES POINTS OF CONTACT (expand as necessary)
| Name |
| Phone Number |
| Area of Responsibility |
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:
SERVICE LOCATIONS
Identify service locations throughout the state.
| LOCATION |
| POINT OF CONTACT |
| PHONE NUMBER |
| AREA(S) OF RESPONSIBILITY |
Return this Bidder’s Profile to Procurement Coordinator at:
Marianna.Adams@wsdot.wa.gov
EXHIBIT A-2 – BIDDER’S PROFILE: RFQQ 2024 0911 PAGE 1
(Rev 2024-04-25) image1.png image2.jpeg
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