C - Offering Entity Acknowledgement Form.pdf
PDF 77 KB Posted
- Attached to
- X1DB--Santa Cruz CA for Medical Space
- Solicitation number
- 36C24W24R0070
- Issued by
-
Department of Veterans Affairs
About this file
This is an Offering Entity Acknowledgement Form for RLP No. 36C24W24R0070 related to a Department of Veterans Affairs Community Based Outpatient Clinic (CBOC) in Santa Cruz, CA. The form requires offerors to provide essential business information including entity name, address, UEI number, tax ID, and authorized official details.
The form indicates this is a set-aside opportunity with options for Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), or Small Business (SB) status. Offerors must be certified in SAM under NAICS code 531120 and verified in VetCert if applicable. The document serves as an official attestation that all provided information is accurate and will be used as a basis for evaluation, with incomplete information potentially resulting in a non-responsive determination.
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Text version
Offering Entity Acknowledgement Form Santa Cruz, CA CBOC
RLP No: 36C24W24R0070
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. 36C24W24R0070. Failure to provide the required information may deem your proposal non-responsive.
Offeror Information
Entity Name:
Address:
UEI Number:
Tax Identification Number:
Authorized Official Name:
Authorized Official Phone Number:
Authorized Official Email:
Authorized Official is Listed in Entity SAM Representations: Yes No Authorized Official is Listed in Entity Operating Agreement: Yes No Date of Submission:
Time Specified for Receipt of Offers:
Offeror Entity/Prime Contractor Status
Prime Contractor Size Status: SDVOSB VOSB SB Offer Entity Currently Certified in SAM under NAICS 531120: Yes No Offer Entity Currently Verified in VetCert: Yes No
Offering Entity POC Signature Date
Offering Entity POC Name
File details come from the government source that posted it. Updated .