CRP Sources Sought-Contractor Information Sheet.docx

Contractor/Vendor Information Sheet

Please fill in all information below, type or print information clearly.

Legal Business Name:

Tax ID No: UEI:

Address:

City, State, Zip Code:

Toll Free Number: Website Address:

Point of Contact:

Phone Number: Fax:

E-mail Address:

Contractor Information Sheet

SBU - CONTRACTING AND ACQUISITIONS

Country of Origin U.S. Firm ___

Size of Business:

Large ___ Small ___

Corporate Status:

Corporation ___ S-Corporation ___ Sole Proprietorship ___ Partnership ___ Other: _______________

Type of Ownership:

Woman ___ Veteran-owned___ (Service-disabled ____) Minority___ None of the Above ___ Other: _________________

Socio-Economic Status:

8(a) Status ___ HUBZone___ Disadvantaged____ Woman Owned___

SDVOSB___

None of the Above ___ Other:_________________

Registered in SAM: Yes No _

DCAA-approved accounting practices: Yes No _

Do you currently do business with the U.S. Government? Yes____ No____

Location of Proposed Warehouse Facility Street:

City, State, ZIP:

Please attach floor plan of proposed facility; to include POV storage area.

Number of Loading docks: With Levelers_____________ Without Levelers__________ Lease Status: