05 - New Albany Offering Entity Acknowledgement Form.pdf
PDF 80 KB Posted
- Solicitation number
- 36C10F24R0055
About this file
This document is an Offering Entity Acknowledgement Form for RLP No. 36C10F24R0055, a solicitation issued by the Department of Veterans Affairs Office of Construction and Facilities Management for a new outpatient clinic in New Albany, Indiana. The form requires the offeror to provide information about their entity, such as name, address, UEI number, tax ID, and authorized official details. The offeror must also confirm their size status (SDVOSB, VOSB, or SB) and whether they are currently certified in SAM under NAICS 531120 and verified in VetCert. The completed form must be submitted by the time specified for receipt of offers. The key details of the related federal contract opportunity are the solicitation number 36C10F24R0055 and the project description of a new outpatient clinic in New Albany, Indiana.
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Text version
Offering Entity Acknowledgement Form New Albany, IN – OPC
RLP ID: 36C10F24R0055
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. 36C10F24R0055. Failure to provide the required information may deem your proposal non-responsive.
Offeror Information
Entity Name:
Address:
UEI Number:
Tax Identification Number:
Authorized Official Name:
Authorized Official Phone Number:
Authorized Official Email:
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:
Offeror Entity/Prime Contractor Status
Prime Contractor Size Status: SDVOSB VOSB SB Offer Entity Currently Certified in SAM under NAICS 531120: Yes No Offer Entity Currently Verified in VetCert: Yes No
Offering Entity POC Signature Date
Offering Entity POC Name
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