RFQQ236- Exhibit A-2- Bidders Profile.docx

EXHIBIT A-2 – BIDDER’S PROFILE

Bidder:

Type/print full legal name of Bidder

BIDDER INFORMATION

Legal name of Bidder:

Address of Bidder:

Note: This must match information from Bidder’s Washington 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). If your TIN is a SSN, state that fact, but do NOT provide the SSN.

If yes, provide Bidder’s MWBE certification no.:

Is your firm a self-certified Washington Small Business?

Note: See Exhibit A-1 – Bidder’s Certification for criteria to qualify as a Washington 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:

If yes, what is your business size (based on annual gross revenue)?

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

Authorized Representative Name:

Email:

Phone:

Contract Administrator Name:

Email:

Phone:

Complete if using sub-contractors as indicated in Exhibit A-1

SUB CONTACTOR

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:

Return this Bidder’s Profile to Procurement Coordinator at:

CLaCourse@walottery.com

EXHIBIT A-2 – BIDDER’S PROFILE PAGE 1

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