Exhibit A-2-Bidders Profile.pdf

EXHIBIT A-2 – BIDDER’S PROFILE: IFB PC236113 PAGE 1

(Rev 2023-05-15)

Supply Section 8543 Armstrong Road SW, Tumwater, WA 89512

EXHIBIT A-2 – BIDDER’S PROFILE

Competitive Solicitation:

No. IFB PC236113 - Flo Core+19.2KW EV Charging Stations

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.: ____________

EXHIBIT A-2 – BIDDER’S PROFILE: IFB PC236113 PAGE 2

BIDDER INFORMATION

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:

EXHIBIT A-2 – BIDDER’S PROFILE: IFB PC236113 PAGE 3

ORDERING/SALES POINTS OF CONTACT (expand as necessary)

Name Phone Number E-mail Area of Responsibility

REFERENCES

Provide a minimum of two (2) 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:

Return this Bidder’s Profile to Procurement Coordinator at:

Pennie.Clark@wsp.wa.gov