Attachment 3 - Information Sheet.pdf
PDF 89 KB Posted
- Attached to
- Inter-Facility Patient Transfer Service Federal contract opportunity
- Solicitation number
- FA486122R0010
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 1 - FA4861-22-R-0010 Statement of Work.pdf | ||
| Attachment 2 - Price List.pdf | ||
| Solicitation - FA486122R0010.pdf |
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Text version
Attachment 1
INFORMATION SHEET
Non-Emergency Patient Transfer Services
TO: 99th Contracting Squadron/PKB 5865 Swaab Blvd Bldg 588 Nellis AFB, NV 89191
FROM: _________________________________________
a. Firm (does) (does not) agree to the establishment of a BPA.
b. Firm (is) (is not) a small business concern.
c. Person(s) to contact for price lists and follow-up information, include telephone number and facsimile number:
SIGNATURE/TITLE DATE
CAGE #: _______________________________
DUNS#: ________________________________
TAX ID#: ________________________________
| FROM 1: |
| FROM 2: |
| FROM 3: |
| FROM 4: |
| facsimile number: |
| 1: |
| 2: |
| CAGE: |
| DUNS: |
| TAX ID: |
| DATE: |
| Check Box1: Off |
| Check Box2: Off |
| Check Box3: Off |
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