ATTACHMENT B SOURCES SOUGHT NOTICE RESPONSE FORM.docx

ATTACHMENT B

SOURCES SOUGHT NOTICE 36C24823Q0842 RESPONSE FORM

Regulated Medical and Hazardous Waste Removal Services

Digital only, no hard copies of capability statements will be accepted. Participants must submit their capabilities no later than the response due date of the sources sought notice.

SECTION I - ORGANIZATION INFORMATION

Provide your organization information:

a. Organization Name:

b. Organization Address:

c. Point of Contact (POC):

d. POC Telephone Number:

e. System for Award Management (SAM) Unique Entity ID:

f. Cage Code:

g. Recommended NAICS for this RFI:

h. Socio-economic Group (SDVOSB, VOSB, 8A…) list all that applies:

i. GSA/FSS or NAC Schedule number, or state “Open Market”:

Provide the following additional organization information:

a. Identify any other companies owned (wholly or in-part) by the owners of this business who provide goods or services under the same or a related NAICS codes.

b. Identify any other companies owned (wholly or in-part) by the owners of this business who provide goods or services that are registered under the same or a related NAICS code with the Center for Veterans Enterprise (CVE); Provide the certification type (SDVOSB/VOSB

c. Do you plan on responding to a solicitation for this requirement with a Joint Venture/subcontractor?

Yes ___, Proceed to section II.

No ___ , Proceed to Section III.

“Choose an item” to display percent.

Subcontractor # 1

Name:

Address:

Phone Number:

DUNS:

Identify the percentage and specific task(s) to be performed by the subcontractor. Use the drop down box to the right to display percentage.

Specific Tasks:

Choose an item.

Identify the percentage and the specific task(s) to be performed by the primary contractor. Use the drop down box to the right to display percentage.

Specific Tasks:

Choose an item.

Subcontractor # 2

Name:

Address:

Phone Number:

DUNS:

Identify the percentage and specific task(s) to be performed by the subcontractor. Use the drop down box to the right to display percentage.

Specific Tasks:

Choose an item.

Identify the percentage and the specific task(s) to be performed by the primary contractor. Use the drop down box to the right to display percentage.

Specific Tasks:

Choose an item.

SECTION III - CAPABILITY STATEMENT

1. Provide a brief explanation of your capability to collect, document and transport regulated medical/hazardous waste. Primary Contractor must be the entity providing the vital and essential services within the Draft Performance Work Statement.

Contractor’s Response:

SECTION IV – RELEVANT EXPERIENCE

Provide two (2) to three (3) Government or Commercial contracts references in which you performed the services described in the DRAFT PWS.

a. Contract Number:

b. Period of Performance:

c. Name of Point of Contact:

d. Point of Contact Phone Number:

e. Point of Contact e-mail Address:

a. Contract Number:

b. Period of Performance:

c. Name of Point of Contact:

d. Point of Contact Phone Number:

e. Point of Contact e-mail Address:

a. Contract Number:

b. Period of Performance:

c. Name of Point of Contact:

d. Point of Contact Phone Number:

e. Point of Contact e-mail Address:

SECTION V – QUESTIONS TO THE CONTRACTING OFFICER

All questions will be answered electronically to all interested party that provided a response to this sources sought notice.

a.

b.

c.

d.