36C26118R0541-001.docx
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- Solicitation number
- 36C26118R0541
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36C26118R0541 Sources Sought Vendor Form.docx
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SOURCES SOUGHT – CONTRACTOR INFORMATION FORM
for 36C26118R0541 IPP USP 797/800 Compliance (Pharmacy)VASNHCS, Reno, Nevada
Use this form to provide contractor’s general information. Please limit response to one page. The box at the bottom of this form may be used to clarify any requested information.
| 1. Contractor Information: |
| DUNS: |
| CAGE Code: |
| Firm Name: |
| Address: |
| Name of POC for firm: |
| Phone Number of POC: |
| Email of POC: |
2. Type of Business: (check all that apply)
| |_| SBA certified 8(a) firm |
| |_| SBA certified HUBZone Small Business |
| |_| Service-Disabled Veteran-Owned Small Business |
| |_| Small Business |
|_| Economically Disadvantaged Women-Owned Small Business
3. Bonding Capacity:
| Surety Name: |
| Maximum bonding capacity per project: |
| $ |
| Aggregate maximum bonding capacity: |
| $ |
4. This space may be used to provide any additional information to clarify the above items only:
Please DO NOT change content of the form
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