Attachment 1.docx

ATTACHMENT TO COMBINED SYNOPSIS/SOLICITATION Page of Pages

IN REFERENCE TO: Solicitation Number 1282MK20Q0021 _ ______ 2 of 3__

ATTACHMENT 1 - QUOTER QUESTIONAIRE

☐ Completed Schedule of Items (page 2) with proposed pricing and delivery costs.

☐ Quoter confirms the attached Specifications has been thoroughly reviewed before submitting a quotation.

☐ The registration process at www.SAM.gov has been successfully completed.

☐ Quoter confirms the provision FAR 52.212-3, the annual representations and certifications, has been electronically completed at www.SAM.gov. The complete provision can be found at https://www.acquisition.gov/far/loadmainre.html.

☐ Contractor Federal Tax ID Number is provided:__________________________

☐ Contractor DUNS number is provided:_________________________

Contractor’s Point of Contact (POC) Information is provided:

Name/Position: Email:

Phone: Fax:

☐ The following questions have been answered as provided below (2 additional pages allowed if additional space required):

1. Estimated Delivery Schedule FOB once order is placed?

2. Within the past 5 years have you failed to complete any work awarded to you or been terminated for default or breach of contract? If yes, explain.

☐ The following three professional references regarding performance of similar work are provided:

1. Name: Organization:

Phone: Email:______________________________________

2. Name: Organization:

Phone: Email:______________________________________

3. Name: Organization:

Phone: Email:

☐ I certify that all of the information provided above is complete, true, and correct to the best of my knowledge.

Sign:______________________________________

Date:_______________________________________

SCHEDULE OF ITEMS

ITEM NO.

SCHEDULE OF SERVICES

EST.

QTY

UNIT

UNIT PRICE

TOTAL AMT.

OR comparable Black Flag Termin-8 Wood Preservative)).