Attachment 1 - Quoter Information Form.docx

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Medical Gases for the Naval Aerospace Medical Institute (NAMI) Hyperbaric Medicine Department, Pensacola, FL
Solicitation number
N6264520R0066
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N6264520R0066.docx DOCX document

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Attachment 1—Quoter’s Information Form Provide two points of contact.

Company Name: _____________________________________________ CAGE Code: _____________________

DUNS: _________________________

TIN: ___________________________

Contact 1 Name: ____________________________________ Title:______________________________________ Phone Number: _____________________________ Email Address: _____________________________

Contact 2 Name: ____________________________________ Title:______________________________________ Phone Number: _____________________________ Email Address: _____________________________

I acknowledge that all items contained in the quote submitted under RFQ N6264520R0066 are true and accurate to the best of my knowledge. I also acknowledge receipt of all amendments to the solicitation.

Printed Name/Title: _____________________________________________

Signature/Date: ________________________________________________

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