5 RLP 36C10F25R0036 Offering Entity Acknowledgement Form Baltimore MD OPC 6 6 2025.pdf
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- Solicitation number
- 36C10F25R0036
About this file
The document is an Offering Entity Acknowledgement Form for a VA (Department of Veterans Affairs) Real Estate Lease Proposal (RLP) for an Outpatient Clinic (OPC) located in Baltimore, MD, with the solicitation number 36C10F25R0036. The form requires potential offerors to provide comprehensive entity information including name, address, UEI number, tax identification number, and authorized official contact details, with specific emphasis on verifying the entity's status in SAM (System for Award Management) and VetCert.
The form captures critical contractor qualifications, including prime contractor size status options of Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), or Small Business (SB), and requires confirmation of SAM certification under NAICS code 531120. Offerors must attest to the accuracy of submitted information, understanding that failure to provide complete details may result in the proposal being deemed non-responsive. The form includes signature lines for both the offering entity's point of contact and space for lessor and VA representatives to acknowledge the submission.
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Text version
Offering Entity Acknowledgement Form Baltimore, MD – Outpatient Clinic (OPC)
RLP ID: 36C10F25R0036
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. 36C10F25R0036. 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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