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 RLP No. 36C10F26R0024, a federal contract opportunity for an Outpatient Clinic (OPC) in South Palm Beach County, Florida. The form serves as a template that offerors must complete and submit to attest that all information provided is accurate and will be used as a basis for proposal evaluation. Failure to provide the required information may result in a non-responsive proposal determination.
The form requires offerors to supply comprehensive entity information including legal entity name, business address, Unique Entity Identifier (UEI) number, Tax Identification Number, and authorized official details (name, phone, and email). Offerors must confirm whether their authorized official is listed in the entity's SAM (System for Award Management) representations and operating agreement. The form also requires offerors to 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. Additionally, offerors must indicate whether they are currently certified in SAM under NAICS code 531120 and verified in VetCert. The form must be signed by the offering entity's Point of Contact with the date of submission and specified time for receipt of offers noted.
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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:________
File details come from the government source that posted it. Updated .