Attachment 3 - Contractor Submittal Form.pdf
PDF 215 KB Posted
- Attached to
- Raised Access Flooring Tiles
- Solicitation number
- W50S9A26QA012
About this file
This document is a Contractor Submittal Form (Attachment 3) for Request for Quote (RFQ) W50S9A-26-Q-A012 issued by the U.S. Air Force for raised computer access floor tiles at Roland R. Wright Air National Guard Base in Salt Lake City, Utah.
The solicitation requires contractors to provide and install new raised computer access floor tiles in accordance with the attached specifications. The contract line item number (CLIN) 0001 specifies a quantity of one each (EA), with contractors required to submit unit pricing and extended pricing. The delivery date is on or before September 1, 2026, with FOB Point Destination for all deliverables. Contractors must be registered in the System for Award Management (SAM) under NAICS code 238330 to be considered responsive and must certify compliance with all specification requirements or identify exceptions. The form requires contractor identification information including company name, SAM Unique Entity Identifier (UEI), CAGE Code, point of contact details, payment terms (Net 30 unless prompt payment discounts are offered), and any applicable GSA contract numbers. An authorized representative must sign and certify that all pricing and representations are current, complete, and accurate.
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RFQ# W50S9A-26-Q-A012: CONTRACTOR SUBMITTAL FORM Page 1
ATTACHMENT 3 - CONTRACTOR SUBMITTAL FORM
Solicitation RFQ# W50S9A-26-Q-A012 Project: Raised Computer Access Floor Tiles
PART I: CONTRACTOR REPRESENTATION & IDENTIFICATION
Please complete all fields in the table below. Ensure your System for Award Management (SAM) registration is active and matching.
No
Field Description Contractor Response
1 Contractor Name
2 SAM UEI
3 CAGE Code
Offeror must be registered in SAM under this NAICS (238330) in order to be considered responsive
5 Point of Contact
6 Address
7 Phone Number
8 Email Address
Payment Terms (Net 30 unless any prompt payment discount terms are offered)
10 GSA Contract # (If applicable)
RFQ# W50S9A-26-Q-A012: CONTRACTOR SUBMITTAL FORM Page 2
PART II: CLIN INFORMATION & PRICING SCHEDULE
CLIN Item Extended Item Description Qty Unit Unit Price ($) Extended Price ($)
0001 Raised Computer Access Floor Tiles
The contractor shall provide and install new raised computer access floor tiles in accordance with Attachment 1 - Specifications.
1 EA
TOTAL PRICE: $
PART III: TECHNICAL COMPLIANCE & PERFORMANCE TERMS
Specifications Attachment Exception Certification:
[ ] The Contractor takes NO EXCEPTION to the requirements in the Specification Document.
(Please check or initial the box to certify compliance)
Place of Performance: Roland R. Wright Air National Guard Base, Salt Lake City, Ut.
• Delivery Date: On or before 01 September 2026
• FOB Point: Destination (All deliverables are FOB Destination)
PART IV: SIGNATURE OF AUTHORIZED REPRESENTATIVE
By signing below, the contractor certifies that the pricing and representations provided in this submittal are current, complete, and accurate.
Authorized Signature: ___________________________________________________
Printed Name & Title: ___________________________________________________
Date: ___________________________________________________
Company Name: ___________________________________________________
| Contractor ResponseContractor Name: |
| Contractor ResponseDUNS Number SAM UEI: |
| Contractor ResponseCAGE Code: |
| 238220Email Address: |
| 238220Payment Terms Net 30 unless any prompt payment discount terms are offered: |
| 238220GSA Contract If applicable: |
| fill_12: |
| 1_3: |
| 2_2: |
| 3_2: |
| 4_2: |
| Extended Price: |
| Point of Contact: |
| Address: |
| Phone Number: |
| Unit Price: |
File details come from the government source that posted it. Updated .