Federal Tax ID No. (TIN) If TIN is a Social Security number, provide only the last four digits Yes No Is your firm certified as a minority or If yes, provide MWBE certification no. woman owned business with OMWBE? Yes No Is your firm a self-certified Washington If yes, what is your business size? State small business? Small Mini Micro Yes No Is your firm certified as Veteran Owned with Washington State Department of If yes, provide WSDVA certification no. Veteran Affairs? Which state or national CART/Captioning certifications does your firm currently have? (Provide copies with your Offer) In which areas of service does your firm specialize, if any? Contract Management Points of Contact Authorized Representative Contract Administrator Name: Name: Email: Email: Phone: Phone: Sales Reporting Representative Sales Reporting Alternate Name: Name: Email: Email: Phone: Phone: Management Fee Representative Management Fee Contact Alternate Name: Name: Email: Email: Phone: Phone: Address to send management fee invoices Company name: Attn: Address: City/State/Zip: Ordering/Sales Points of Contact (expand as necessary) Name Phone Number E-mail Area of Responsibility
Federal Tax ID No. (TIN) If TIN is a Social Security number, provide only the last four digits Is your firm certified as a minority or woman owned business with OMWBE? Yes No If yes, provide MWBE certification no. Is your firm a self-certified Washington State small business? Yes No If yes, what is your business size? Small Mini Micro Is your firm certified as Veteran Owned with Washington State Department of Veteran Affairs? Yes No If yes, provide WSDVA certification no. Which state or national CART/Captioning certifications does your firm currently have? (Provide copies with your Offer) In which areas of service does your firm specialize, if any? Contract Management Points of Contact Authorized Representative Name: Email: Phone: Contract Administrator Name: Email: Phone: Sales Reporting Representative Name: Email: Phone: Sales Reporting Alternate Name: Email: Phone: Management Fee Representative Name: Email: Phone: Management Fee Contact Alternate Name: Email: Phone: Address to send management fee invoices Company name: Attn: Address: City/State/Zip: Ordering/Sales Points of Contact (expand as necessary) Name Phone Number E-mail Area of Responsibility
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