Att 007 21R1909 Proposal Submission Form.pdf

Combined Synopsis/Solicitation (FAR 12.603 and FAR 5.207)

M67854-21-R-1909

Trigger Finger Mitten System

Attachment 007 – Proposal Submission Form

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Company Information

Company Name

Cage Code Tax Payer ID DUNS Code

Street Address

City

State Zip Code

Phone Number

Fax Number Website

Business Type (e.g. Large, Small, 8(a), etc.) In Accordance With FAR 19.001, https://www.acquisition.gov/browse/index/far)

Point of Contact Information

Point of Contact Name

Telephone Number Email Address

M67854-21-R-1909

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Price:

CLIN Description Quantity Unit of

Issue Unit Price Total Price

Trigger Finger Mitten System – Pre-

Production (sizes Small, Medium, Large, X-large)

100 Each $ $

Trigger Finger Mitten System (sizes

Small, Medium, Large, X-large) 36,000 Max Each $ $

0003 CDRLs Not Separately Priced

Berry Amendment Self Certification:

I, , in submitting this offer under solicitation number M67854-21-R-1909, affirm that only products compliant with the Berry Amendment (10 USC 2533a) will be delivered to the Government. As such, all items delivered, either as end products or components, will be grown, reprocessed, reused, or produced in the United States (as defined in DFARS 252.225-7012(b) included by reference herein). This certification covers all materials (including those of all components) and components supplied by subcontractors at any tier, and all labor (including that of all intervening processes), whether performed by the Offeror or any of its subcontractors at any tier.

M67854-21-R-1909

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Past Performance:

Past Performance Citation 1

Contract Number: Contract Type:

Total Contract Value: Period of Performance:

Customer/Agency:

Point of Contact (Name and email address):

M67854-21-R-1909

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Description of work, to include basis for relevancy to subject procurement:

Past Performance Citation 2

Contract Number: Contract Type:

Total Contract Value: Period of Performance:

M67854-21-R-1909

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Past Performance Citation 3

Contract Number: Contract Type:

Total Contract Value: Period of Performance:

M67854-21-R-1909

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The best value offer that conforms to the RFP may be selected for award. In order to be compliant and eligible for award, the Offeror must meet all solicitation requirements. No deviations will be accepted.

M67854-21-R-1909

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Discount Terms (NET 30 if unspecified):

FOB Destination Compliance (circle one):

YES NO (see FAR 52.247-34)

Carefully review all documents before signing

Offeror’s Authorized Representative's Typed or Printed Name Position or Title

Offeror’s Authorized Representative's Signature Date