Exhibit N Offering Entity Acknowledgement Form.docx

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Attached to
X1DB--Amendment1 Answers to Pre-Proposal Conference Questions
Solicitation number
36C25024R0068
Issued by

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This document is the Offering Entity Acknowledgement Form for Request for Lease Proposals (RLP) No. 36C25024R0068 issued by the Department of Veterans Affairs (VA) Veterans Integrated Service Network 10 for a Community Based Outpatient Clinic (CBOC) in Warsaw, Indiana.

The RLP is set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSBs) and seeks to lease 15,000 ABOA square feet of medical office space and 60 parking spaces for the VA's use as a CBOC in Warsaw. The Offering Entity Acknowledgement Form requires the offeror to provide information about their business, such as name, address, UEI, DUNS number, tax ID, authorized official contact details, small business status, and verification of SAM and VetCert registration. The offer must be submitted by the date and time specified in the form.

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Other files

File Type Posted
Answers to Pre-Proposal Conference Questions.pdf PDF
36C25024R0068 0001.docx DOCX document
RLP 36C25024R0068 Warsaw Indiana CBOC.pdf PDF
Exhibit M Operation and Maintenance Plan _Sample.pdf PDF
36C25024R0068_1.docx DOCX document
Exhibit C Conceptual Floor Plan with Program Requirements.pdf PDF
Exhibit O Past Performance Survey.docx DOCX document
Exhibit K DOL Wage Determiniation Kosciusko 06.14.2024.pdf PDF
Exhibit E Security Unit Price List FSL II.xlsx XLSX spreadsheet
Exhibit U Pre-Proposal Registration Form.docx DOCX document
Exhibit R Contractor Qualifications and Financial Information GSA527.pdf PDF
Exhibit T Janitorial Requirements.pdf PDF
Exhibit A 36C25024L0013.pdf PDF
Exhibit B Agency Specific Requirements Warsaw.pdf PDF
Exhibit F 3516 Solicitation Provisions Dec 2023.pdf PDF
Exhibit S Delineated Area.pdf PDF
Exhibit Q Architect-Engineer Qualifications SF330.pdf PDF
Exhibit H Form 1364 Proposal to Lease Space Jan 2023.pdf PDF
Exhibit D FSL Level II Security Requirements.pdf PDF
Exhibit G 3517B General Clauses Dec 2023.pdf PDF
Exhibit I GSA1217-16e.pdf PDF
Exhibit P Master TICS Table.xlsx XLSX spreadsheet
Exhibit L FAR 52.204-24 and 52.204-26.pdf PDF
Exhibit J GSA Form 12000 for Prelease Fire Protection and Life Safety Evaluation for an Office Building Part A Part B.pdf PDF
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Attachment G Offering Entity Acknowledgement for RLP No.: 36C25024R0068 Warsaw, IN CBOC The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No.: 36C25024R0068. Failure to provide the required information may deem the proposal non-responsive.

Offeror Information Offering Entity Name:

Address:

Offering Entity Unique Entity Identifier (SAM UEI):

Offering Entity DUNS Number:

Offering Entity Tax Identification Number:

Authorized Official Name:

Authorized Official Phone Number:

Authorized Official E-mail:

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:

Offering Entity/Prime Contractor Size Status:

SDVOSB |_| VOSB |_| SB |_|

Offering Entity Currently Certified in SAM under NAICS 531120 as defined at FAR 52.219-1 Small Business Program Representations |_| Offering Entity Currently Verified in VetCert: YES |_| NO |_| N/A |_|

____________________________________
Offering Entity POC SignatureDate

Offering Entity POC Name

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