Attachment 5 - Questionnaire (Cold Weather Pumping and Thawing).docx

COMBINED SYNOPSIS/SOLICITATION

QUESTIONNAIRE

Cold Weather Pumping and Thawing

COMPANY NAME: ______________________________________________________

ADDRESS: ____________________________________________________________

PHONE NUMBER: __________________

EMAIL ADDRESS: __________________________________

CAGE: __________

DUNS: __________________

SAM Unique Entity ID: _________________

1. Does your firm have an active registration in the System for Award Management (SAM)? ☐ Yes ☐ No Expiration Date: _______________

2. Does your firm have any active exclusions in SAM? ☐ Yes ☐ No

If so, please provide a brief explanation: _________________________________________________________________________________________________________________________________________________________________________________________________________

3. Does your firm have completed/updated the FAR & DFARS Representations and Certifications in SAM? ☐ Yes ☐ No Date of Last Update: ________________

4. Does your firm have updated Section 889 representations, Part A and B, within their FAR & DFARS Representations and Certifications in SAM? OCT 2020 or later versions for FAR 52.204-24, 52.204-26 and 52.212-3 are now available in SAM.

☐ Yes ☐ No

5. Is your firm eligible for participation in one of the following small business programs? ☐ Yes ☐ No

If so, please indicate the program. The North American Industrial Classification System (NAICS) code is 484210, Used Household and Office Goods Moving and the small business size standard is $30 million.

☐ Small Business (SB) ☐ 8(a) ☐ Small Disadvantage Business (SDB) ☐ Women Owned Small Business (WOSB) ☐ Economically Disadvantage Women Owned Small Business (EDWOSB) ☐ Veteran Owned Small Business (VOSB) ☐ Service Disabled Veteran Owned Small Business (SDVOSB) ☐ HUBZone ☐ Other: __________________________________________________________

6. Does your firm have all the technical/performance capabilities to provide all personnel, equipment, supplies, transportation, tools, materials, supervision, and other items and non-personal services necessary to provide drayage services as defined in the Performance Work Statement (PWS)? ☐ Yes ☐ No

7. Does your firm have the capabilities to provide the services at Fort Wainwright, AK as specified in the attached PWS? ☐ Yes ☐ No

8. Does your firm have the capabilities to comply with the period of performance and schedule required in the attached PWS? ☐ Yes ☐ No

9. Does your firm have a contract with the General Services Administration (GSA) that could satisfy the requirements in the PWS? ☐ Yes ☐ No

If so, please provide contract number: ____________________________________

Questionnaire completed by:

NAME & TITLE SIGNATURE