36C25025R0027 Exhibit N Offering Entity Acknowledgement Form.pdf

This is an Offering Entity Acknowledgement form for a federal contract opportunity related to a Defiance, Ohio Community Based Outpatient Clinic (CBOC). The form is designated as RLP Number 36C25025R0027 and references evaluation under RLP No. 36C25025R00207. Offerors are required to attest that all information provided is accurate, with failure to provide required information potentially rendering the proposal non-responsive.

The form requires submission of standard offeror identification information including the offering entity name, address, SAM Unique Entity Identifier (UEI), DUNS number, and Tax Identification Number. Offerors must designate an authorized official and provide their contact information, along with confirmations that the official is listed in both the entity's SAM representations and operating agreement. The form includes small business program representations with size status options for Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), or Small Business (SB), and requires certification status under NAICS 531120 as defined in FAR 52.219-1. Offerors must also indicate whether they are currently verified in VetCert. The form concludes with signature and date blocks for the offering entity point of contact and includes fields for submission date and specified time of receipt of offers.