S-10000-00003770 Attachment B.pdf
PDF 122 KB Posted
- Attached to
- Vocational Rehabilitation Job Placement Services
- Solicitation number
- S-10000-00003770
- Issued by
- Marion County, Oregon
About this file
The document provided is Attachment B to a Request for Application (RFA) issued by the Oregon Department of Human Services (ODHS) Office of Vocational Rehabilitation (VR) for Vocational Rehabilitation Job Placement Services. The RFA seeks applications from qualified businesses, non-profit organizations, and self-employed individuals to provide employment support services to VR participants. Applicants must indicate the counties in Oregon for which they are applying to provide these services. The document collects key applicant information such as legal name, address, contact person, and business designation.
The RFA requires applicants to have current business registration with the Oregon Secretary of State at the time of contract execution. The contract term is not specified. The document does not include pricing terms, set-asides, incumbent information, funding details, or other salient commercial terms.
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Text version
RFA – OregonBuys Bid: S-10000-00003770 Attachment B
S-10000-00003770 Page 1 of 1
ATTACHMENT B – CONTRACTOR INFORMATION
If Applicant is awarded a Contract, VR will use the following information for the Applicant’s Contract to provide VR Job Placement Services.
APPLICANT INFORMATION
C1
Legal name of Applicant
Doing business as (if applicable)
Address
City, State, Zip
APPLICANT CONTACT
This is the person VR will contact for Contract negotiations.
C2
Name
Title
Address
Phone
Email address
SERVICE LOCATION DESIGNATION
Applicant shall check the boxes to indicate the county or counties for which the Applicant is applying to provide VR Job Placement Services.
C3
Baker Benton Clackamas Clatsop Columbia Coos
Crook Curry Deschutes Douglas Gilliam Grant
Harney Hood River Jackson Jefferson Josephine Klamath
Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Polk Sherman Tillamook Umatilla
Union Wallowa Wasco Washington Wheeler Yamhill
All Counties
BUSINESS INFORMATION
C4
Business Designation
(Check one)
Professional Corporation Nonprofit Corporation Limited Partnership
Limited Liability Company Limited Liability Partnership
Sole Proprietorship Corporation Partnership NA_________________
Secretary of State Business Registration
State of Registration ___________________ Registry ID#_____________________
Oregon Secretary of State registration must be current at the time of Contract execution.
File details come from the government source that posted it. Updated .