36C25622R0030 EXHIBIT H-Contractor Information.docx
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- Attached to
- Z2FB--Biloxi MATOC-Seed Project Project #520-22-122 FCA Corrections BLDG 17 - 36C25622R0030
- Solicitation number
- 520-22-122
About this file
This document contains a contractor information form and details of a related federal contract opportunity. The contractor information form requests company and point of contact details for the purpose of completing contractual documents associated with solicitation number 520-22-122. This solicitation is for a MATOC seed project to support corrections building 17 at the Veterans Health Administration Veterans Integrated Service Network 16. Relevant details include the project and solicitation numbers, the federal agency and location involved, and a request for past performance contacts.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project No. 520-22-122 FCA Corrections BLDG 17-MATOC Seed Project 36C25622R0030 Solicitation Exhibit H Contractor General Information
1. CONTRACTOR INFORMATION:
| Name of Company: ______________________________ | |
| Name: _______________________________ | |
| Title: _______________________________________ | |
| Main Office Address: _____________________________ | |
| _______ | |
| Satellite/Branch Office Address:_______________________________ |
| E-Mail Address: _________________ |
| Phone No: __________________________________________ |
Fax No: ___________________________________________
TAX ID Number: __________
DUNS Number: ________________________ _______________________
2. CONTRACTOR'S SIGNATURE:
In accordance with Federal Acquisition Regulations Part 4, contractual documents (e.g. bids, proposals, awards, modifications, etc.) shall be completed and signed by the Contractor as follows:
(a) Individuals. Signed by the individual.
(b) Individual doing business as a firm. Signed by that individual, and the signature shall be followed by the individual's typed, stamped, or printed name and the words, "an individual doing business as __________________ (insert name of firm)".
(c) Partnership. Signed in the partnership name. Prior to award, provide list of all partners and designate which partners have authority to bind the partnership.
(d) Corporations. Signed in the corporate name followed by the word "by" and the signature, and title of the person authorized to sign. Prior to award, provide list of individuals who have authority to bind the corporation.
(e) Joint Ventures. Signed by each participant in the joint venture in the manner prescribed in (a) through (d) above. (Must be registered in SAM and VIP)
(f) Agents. When an agent is to sign the contract, other than as stated in paragraph (a) through (e) above, the agent's authorization to bind the principal must be established by evidence satisfactory to the contracting officer.
3. Past Performance (CPARS) Point of Contact (within your company), include name and email address:
File details come from the government source that posted it. Updated .