Attachment A.docx

Attachment A - Contractor's Response Form to Sources Sought Notice

Sources Sought Information and Capabilities for Philips Diagnostic Imaging System Services

Please fully complete each section of the form below.

Company Name: Company Address: DUNS Number: Point of Contact: Phone Number: Email Address:

(1) Is your company considered small under the NAICS code?

(2) Are you the manufacturer or distributor? What is the manufacturing country of origin of these items?

(3) If you’re a small business and you are an authorized vendor, distributor/reseller for the items identified in Attachment B (or equivalent product/solution), do you alter; assemble; modify; the items requested in any way? If you do, state how and what is altered; assembled; modified?

(4) Does your company have an FSS contract with GSA or the NAC or are you a contract holder with NASA SEWP or any other federal contract (e-CAT, etc.)? If so, please provide the contract type and number.

(5) If you are an FSS GSA/NAC, e-CAT or NASA SEWP contract holder or other federal contract holder, are all the referenced items/solutions available on your schedule/contract and what is the contract number?

Socio-economic Classification in Accordance with NAICS code 339114 Dental Equipment and Supplies Manufacturing (check all that apply)

· Small Business

· Service-Disabled Veteran Owned Small Business (SDVOSB)

· Verified SDVOSB by www.vip.vetbiz.gov

· Veteran Owned Small Business (VOSB)

· Verified VOSB by www.vip.vetbiz.gov

· Small Disadvantage Business

· Women-owned Small Business

· Economically Disadvantaged Small Business

· HUBZone

· 8(a) Certified

· Other:

Detailed Information:

1. What percentage of the contracted services can your company complete as the prime contractor? %

2. What percentage of the contracted services would your company subcontract?

3. Please attach your Company’s Capability Statement (1-2 pages maximum).