Attachment 3 - Offerors Information Form.docx
DOCX document 12 KB Posted
- Attached to
- Mental Health services for Naval Surface Force Atlantic Force Resiliency/Toughness Program Federal contract opportunity
- Solicitation number
- N6264521R0007
About this file
This document contains an offeror's information form and details of a solicitation for mental health services. The solicitation seeks non-personal services including a registered nurse clinical manager, licensed clinical social worker, psychiatric technician, biomedical equipment repair technician, psychologist, medical administrative assistant, data analyst, and clinical staff support specialist. These services are required to support the Force Resiliency/Toughness Program at Naval Station Norfolk, Virginia, Commander Naval Surface Squadron 14 in Mayport, Florida, and Commander Littoral Combat Ship Squadron 2, also in Mayport, Florida. The solicitation number is N6264521R0007 and was issued by the Department of the Navy Naval Supply Systems Command to provide these mental health services. Offerors must complete the attachment 3 offeror's information form providing two points of contact including names, titles, phone numbers and emails. Offerors also must acknowledge receipt of all solicitation amendments and the accuracy of all proposal items by signature.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment 1 N6264521R0007.docx | DOCX document | |
| Attachment 6 - Malpractice Insurance Certification Form.docx | DOCX document | |
| Attachment 6 - Malpractice Insurance Certification Form.docx | DOCX document | |
| Attachment 7 - DD Form 254.pdf | ||
| Attachment 1 - Past Performance Information Sheet.docx | DOCX document | |
| Attachment 2 - SAM Certification Sheet.docx | DOCX document | |
| Attachment 4 - Pricing Workbook for N62645-21-R-0007.xlsx | XLSX spreadsheet | |
| Attachment 5 - Establish U.S. Citizenship.docx | DOCX document | |
| N6264521R0007.docx | DOCX document |
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Text version
Attachment 3—Offeror’s Information Form Provide two points of contact. The points of contact shall be officials from the prime contractor or a member of the joint venture.
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 proposal submitted under solicitation N62645-21-R-0007 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: ________________________________________________
File details come from the government source that posted it. Updated .