17 - Offering Entity Acknowledgement Form.pdf

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Attached to
X1DB--Canton OH Outpatient Clinic 62, 784 ANSI/BOMA RLP Extension
Solicitation number
36C10F26R0052
Issued by

About this file

This is an Offering Entity Acknowledgement Form for RLP No. 36C10F26R0052, a federal contract opportunity issued by Canton, OH OPC. The form serves as a template for offerors to provide required entity information and attest to its accuracy as a condition of proposal evaluation. Failure to provide the requested information may result in a nonresponsive proposal determination.

The form requires offerors to submit entity identification details including legal name, address, Unique Entity Identifier (UEI), Tax Identification Number, and authorized official contact information (name, phone, email). Offerors must confirm whether the authorized official is listed in the entity's SAM representations and operating agreement. The form also requires offerors to identify their prime contractor size status, selecting from Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), or Small Business (SB) categories. Additionally, offerors must certify current SAM registration under NAICS 531120 and VetCert verification status. The form must be signed by an authorized point of contact with submission date and time specifications included.

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Offering Entity Acknowledgement Form Canton, OH OPC RLP ID: 36C10F26R0052

The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. 36C10F26R0052. 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

File details come from the government source that posted it. Updated .