Exhibit B Contractor Info Fillable.pdf
PDF 139 KB Posted
- Solicitation number
- CC0017-JMC
- Issued by
- Pierce County, Washington
About this file
This document is Exhibit B - Contractor Information from Washington State University's Procurement and Contract Services, designed to be submitted with a response to Solicitation No. WSU. The form requires detailed information about a potential contractor, including legal business name, address, contact information, business structure, year established, federal and state tax identification numbers, principal officers, and any current or former Washington State employee relationships.
The form seeks transparency regarding potential conflicts of interest by requiring contractors to disclose any employees who have worked for the State of Washington within the past 24 months, as well as any current employees or governing board members who are also Washington State employees or former employees. Contractors must provide names, agencies, titles, separation dates, and responsibilities for such individuals. This comprehensive disclosure helps ensure ethical procurement practices and prevents potential conflicts of interest in the state contracting process.
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| File | Type | Posted |
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| Exhibit C Fee Sheet.xlsx | XLSX spreadsheet | |
| Exhibit A Certifications Fillable.pdf | ||
| CC0017-JMC WSU AV Services Stichery Expo.pdf |
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Text version
SOLICITATION NO. WSU
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:
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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