36C26119R0027-034.docx

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104

REQUEST FOR INFORMATION (RFI) FORM

SOLICITATION: 36C26119R0027 DESIGN BUILD INSTALLPATIENT ELOPEMENT

NOTE: ALL PRE-BID INQUIRIES SHALL BE SUBMITTED VIA EMAIL TO

charee.harris@va.gov BY AN EDITABLE USE OF THIS FORM. Please identify, in numerical sequence, each set of inquiries that you send.

Question(s) is/are regarding the solicitation [ ] Question(s) is/are regarding the drawings, specifications, technical data [ ]

Company Name and Offeror: ________________________________________________

From (person submitting question): _________________________________________________________

Date of Inquiry: __________________________________________

Phone Number: ___________________________

Proposal Inquiry: (Type inquiry below)

Proposal RFI #1 –

Proposal RFI #2 –

Proposal RFI #3 -

Add additional as necessary