04-Buffalo Offering Entity Acknowledgement Form.docx
DOCX document 40 KB Posted
- Solicitation number
- 36C10F25R0010
About this file
The document is an Offering Entity Acknowledgement Form for a VA lease procurement (Solicitation Number 36C10F25R0010) for a Buffalo, NY Research and Development facility. The form requires detailed information from potential offerors, including entity name, SAM UEI number, tax identification number, and authorized official contact details. Vendors must indicate their business size status, which includes options for Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), Small Business (SB), or Other than Small Business, with additional certification requirements for NAICS 531120 and VetCert verification. The solicitation is issued by the Department of Veterans Affairs Office of Construction and Facilities Management and seeks a 33,425 square foot ANSI/BOMA R&D facility in Buffalo, NY.
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Text version
Attachment G
Offering Entity Acknowledgement RLP No. 36C10F25R0010 Buffalo, NY, R&D Facility
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in the above-referenced lease procurement. Failure to provide the required information may deem your proposal non-responsive.
Offeror Information
Offering Entity Name:
Address:
Offering Entity SAM UEI Number:
Offering Entity Tax Identification Number:
Authorized Official Name:
Authorized Official Phone Number:
Authorized Official E-mail:
| Authorized Official is Listed in Entity SAM Representations: | |_| Yes |_| No |
| Authorized Official is Listed in Entity Operating Agreement: | |_| Yes |_| No |
Date of Submission:
Time Specified for Receipt of Offers:
| Offering Entity/Prime Contractor Size Status: | SDVOSB | |_| |
| VOSB | |_| | |
| SB | |_| |
Other than Small Business |_|
Offering Entity Currently Certified in SAM under NAICS 531120 |_|
Offering Entity Currently Verified in VetCert |_|
| ________________________ | ________________ |
| Authorized Official Signature | Date |
Authorized Official Name
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