Attachment 3 - Offeror Information and Certification.pdf

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Attached to
FA485526Q0027 - Building 1265 Boiler Replacement
Solicitation number
FA485526Q0027
Issued by

About this file

This is a template form for offeror information and certification required as part of a federal contract solicitation response.

The form requires offerors to provide company identification information including company name, CAGE code, and UEI number. Offerors must also supply business size information consisting of number of employees and total yearly revenue, which are marked as required to determine size classification under the applicable NAICS code for the solicitation. The form includes checkboxes for offerors to confirm inclusion of standard proposal documents: technical capability offer, price proposal worksheet, offeror information document, and conflict of interest statement. Offerors must indicate whether representations and certifications are attached to the submission or maintained in the System for Award Management (SAM) at sam.gov, and must confirm their registration status in SAM. The form concludes with a certification statement and signature block requiring an authorized company representative to sign and date the submission, with the signatory certifying authority to legally bind the company and acknowledging receipt of all solicitation addendums.

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Text version

Attachment 3 – Offeror Information & Certification

Company Name:

Cage Code:

UEI Number:

*Number of Employees:

*Total Yearly Revenue:

*Information Required to determine size of business for the NAICS for this solicitation.

This offer includes the following documents:

☐ Offer (Technical Capability) ☐ Price Proposal Worksheet ☐ Offeror Information Document ☐ Conflict of Interest Statement

Representations and Certifications are ☐ attached to this document OR ☐ are contained in the System for Award Management (SAM) located at https://sam.gov/.

Offeror confirms that it ☐ IS ☐ IS NOT registered in the System for Award Management.

By providing my signature I, the undersigned, certify that I am an individual who has the authority to sign for and legally bind the Company and hereby submit this offeror for the Company. My signature also acknowledges receipt of any and all addendums issued for this solicitation.

Signature Date

Printed Name and Title of Authorized Agent https://sam.gov/content/home

Text1:
Text2:
Text3:
Text4:
Text5:
Check Box6: Off
Check Box7: Off
Group9: Off
Group10: Off
Text10:
Date11_af_date:
Check Box8: Off
Check Box9: Off

File details come from the government source that posted it. Updated .