13. North Kansas City Offering Entity Acknowledgement Form.docx
DOCX document 39 KB Posted
- Solicitation number
- 36C10F25R0034
About this file
The document is an Offering Entity Acknowledgement Form for a VA Office of Construction and Facilities Management solicitation (RLP No. 36C10F25R0034) for a North Kansas City OPC project. The form requires potential offerors to provide key entity information including UEI number, tax identification number, authorized official contact details, and contractor status, with specific emphasis on verifying small business and veteran-owned business certifications.
The form indicates critical submission requirements, including verification of SAM (System for Award Management) representation, entity operating agreement status, and certification under NAICS code 531120. Offerors must specify their prime contractor status, with options for Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), or Small Business (SB) categories. The document is part of a solicitation for a VA construction project in North Kansas City, Missouri, with specific attention to compliance and verification of business credentials.
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Attachment G Offering Entity Acknowledgement Form North Kansas City, MO CBOC RLP No: 36C10F23Q0091
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. 36C10F23R0062. 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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