17 RLP 36C10F26R0024 Offering Entity Acknowledgement Form SPB County FL OPC 7_17_2026.pdf
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- Solicitation number
- 36C10F26R0024
About this file
This is an Offering Entity Acknowledgement Form for a federal contract opportunity related to an Outpatient Clinic (OPC) in South Palm Beach County, Florida, identified as RLP No. 36C10F26R0024.
The form is a template designed to collect essential offeror information and certifications required for proposal evaluation. Offerors must provide entity name, address, UEI number, tax identification number, and authorized official contact details. The form requires attestation that the authorized official is listed in both the entity's SAM representations and operating agreement. Offerors must declare their prime contractor size status, selecting from Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), or Small Business (SB) categories. The form includes certification requirements regarding SAM registration under NAICS code 531120 (Lessors of Real Property) and VetCert verification status. Completion of all required information is mandatory, with failure to provide such information potentially resulting in proposal non-responsiveness. The form must be signed by the offering entity's point of contact with submission date and time documented.
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Text version
Offering Entity Acknowledgement Form South Palm Beach County, FL – Outpatient Clinic (OPC)
RLP ID: 36C10F26R0024
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. 36C10F26R0024. 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
Lessor: ________ VA:________
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