Attachment__3_AG-6395-SS-17-0132_.pdf

Attachment3_Sources Sought - AG-6395-SS-17-0132

Name of company______________________________________________________________

Phone# __________________________________ fax# ____ ___________________

Point of contact Name______________________________________________________________

Email Address ____________________________________________________________________

Any entity wishing to do business with the federal government under a Federal Acquisition Regulation (FAR)-based contract must be registered in SAM at http://sam.gov.

****REGISTRATION IS FREE*** For FREE registration assistance please contact http://www.aptac-us.org/new/Govt_Contracting/find.php or call 1866-606-8220

Any entity doing business with the Federal Government must also obtain a Dunn and Bradstreet number. If your company does not have a DUNS number, you may contact Dun and Bradstreet directly to obtain one by calling 1- 866-705-5711or via the following website: http://fedgov.dnb.com/webform

Current SAM Registration Yes [ ] No [ ]

DUNS#_____________________

Please provide the following information regarding Fedbizops Sources Sought Notice# AG-6395-SS-17-0132 Please reply by 4:PM (MT) on 07/28/2017

INTERESTED PARTIES PLEASE RETURN ATTACHMENT 3 ON OR BEFORE NOTICE DUE

DATE AND TIME TO

Carol Dingess Contracting Officer Notice#AG-6395-SS-17-0132

USDA/ APHIS/MRPBS/AAMD

2150 Centre Avenue Building - B ( MS - 2E6) Fort Collins, CO 80526 ph:970-494-7360 Cell:612-224-0970

Fax: 970-472-1897 (Attn: Carol Dingess - 2E20) Carol.Dingess@aphis.usda.gov http://sam.gov/ http://fedgov.dnb.com/webform mailto:Carol.Dingess@aphis.usda.gov

Attachment3_Sources Sought - AG-6395-SS-17-0132

Name of company_________________________________________

Business Type - MFG [ ] Supplier/Distributor [ ] Other _____________________

Please check all that may apply:

Number of Employees __ Less than 1,250

__ 1,251 OR MORE

[ ] Small Business Concerns (Jan 2011) (15 U.S.C. 637(d)(2) and (3)).

[ ] Small Economically Disadvantaged Business (Jul 2013) (15 U.S.C. 637(m).

[ ] Service-Disabled Veteran-Owned Small Business ((Nov 2011) (15 U.S.C. 657 f).

[ ] Certified HUBZone Business (Nov 2011) (15 U.S.C. 657a

[ ]Other_______________________________________

[ ] Services available on GSA Contract #___________________________________

Products Offered:

Betadine Manufacturer Brand Name Offered______________________________________________

Product is manufactured in the U.S. ?

[ ] Yes [ ] No – Country________________________________

Betasept Manufacturer Brand Name Offered______________________________________________

Product is manufactured in the U.S. ?

[ ] Yes [ ] No – Country________________________________ http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t13t16+492+90++%2815%29%20%20AND%20%28%2815%29%20ADJ%20USC%29%3ACITE%20%20%20%20%20%20%20%20%20