5 RLP 36C10F25R0035 Offering Entity Acknowledgement Form Port St Lucie FL OPC.pdf
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- Solicitation number
- 36C10F25R0035
About this file
The document is an Offering Entity Acknowledgement Form for a Department of Veterans Affairs (VA) solicitation (RLP ID: 36C10F25R0035) for the Port St. Lucie, FL Outpatient Clinic (OPC). The form requires potential offerors to provide comprehensive entity information, including entity name, address, UEI number, tax identification number, and authorized official contact details.
The form includes sections for verifying the offeror's status, specifically seeking information about prime contractor size status (options include SDVOSB, VOSB, SB), SAM certification under NAICS 531120, and VetCert verification. Offerors must attest to the accuracy of the provided information, with a warning that failure to provide required details may result in the proposal being deemed non-responsive. The form concludes with spaces for the offering entity's point of contact signature and name, as well as signature lines for the lessor and VA representatives.
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Text version
Offering Entity Acknowledgement Form Port St. Lucie, FL – Outpatient Clinic (OPC)
RLP ID: 36C10F25R0035
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. 36C10F25R0035. Failure to provide the required information may deem your proposal non-responsive.
Offeror Information
Entity Name:
Address:
UEI Number:
Tax Identification Number:
Authorized Official Name:
Authorized Official Phone Number:
Authorized Official Email:
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:
Offeror Entity/Prime Contractor Status
Prime Contractor Size Status: SDVOSB VOSB SB Offer Entity Currently Certified in SAM under NAICS 531120: Yes No Offer Entity Currently Verified in VetCert: Yes No
Offering Entity POC Signature Date
Offering Entity POC Name
Lessor: ________ VA:________
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