07 - Offering Entity Ack Form.pdf
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- X1DB--VA Outpatient Clinic, Rolla, Missouri
- Solicitation number
- 36C10F22R0047
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Text version
REQUEST FOR LEASE
PROPOSALS (RLP)
OCT 2019
RLP No. 36C10F22R0047
COMMUNITY-BASED OUTPATIENT CLINIC
Rolla, MO, VA CBOC
Offering Entity Acknowledgement for RLP No.: 36C10F22R0047
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No.: 36C10F22R0047. Failure to provide the required information may deem your proposal non-responsive.
Offeror Information
Yes No
Offering Entity Name:
Address:
Offering Entity UEI:
Offering Entity Tax Identification Number:
Authorized Official Name:
Authorized Official Phone Number:
Authorized Official E-mail:
Authorized Official is Listed in Entity SAM Representations:
Date of Submission:
Time Specified for Receipt of Offers:
Offering Entity/Prime Contractor Size Status: SDVOSB
VOSB
SB
Offering Entity Currently Certified in SAM under NAICS 531120
Offering Entity Currently Verified in VetBiz
Offering Entity POC Signature Date
Offering Entity POC Name
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