A21 - (B) Contractor Information Sheet.pdf

CONTRACTOR INFORMATION SHEET

NAME:

Person #1: SSN:

Person #2: SSN:

IN THE EVENT OF AWARD, ISSUE PURCHASE ORDER TO (This must the exact information that is listed in System for Award Management profile):

Name: Home Phone #:

Address: Cell Phone #:

City: State: Zip:

E-mail address:

SAM UEI: CAGE Code:

PREVIOUS EXPERIENCE: (Dates, Location, Supervisor, Phone #)

OTHER WORK EXPERIENCE(S): (Attach resume for both persons with quote)

Person #1: ________________________________________ Person #2: ________________________________________

NRRS/COMPUTER EXPERIENCE: (check all that apply) Person #1 Person #2 Cash Register/Money Counting NRRS Software (Park Office, ORMS, Field Mgr.) General Computer Experience Other:

SIGNATURES:

Person #1: Person #2:

**THIS SHEET MUST BE COMPLETED & RETURNED WITH YOUR QUOTE**