Exhibit K- Offering Entity Acknowledgement Form.docx

DOCX document 36 KB Posted

Attached to
Request for Lease Proposals-Findlay, OH CBOC (NEW)
Solicitation number
36C25023R0072
Issued by

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This document contains an acknowledgement form and details of a related federal contract opportunity. The acknowledgement form is to be completed by any offering entity responding to Request for Lease Proposals 36C25023R0072 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The form requires the offering entity to provide identifying and eligibility information. This includes the entity's name, address, DUNS number, tax ID, and certifications regarding small business designations. By signing the form, the offering entity attests that the information is accurate and can be used for evaluation purposes under the lease proposal solicitation. That solicitation seeks offers for a new Findlay, OH Community Based Outpatient Clinic with a time specified for receipt of offers.

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Attachment G Offering Entity Acknowledgement for RLP No.: 36C25023R0072 Findlay, OH CBOC The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No.: 36C25023R0072. Failure to provide the required information may deem the proposal non-responsive.

Offeror Information Offering Entity Name:

Address:

Offering Entity Unique Entity Identifier (SAM UEI):

Offering Entity DUNS Number:

Offering Entity Tax Identification Number:

Authorized Official Name:

Authorized Official Phone Number:

Authorized Official E-mail:

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:

Offering Entity/Prime Contractor Size Status:

SDVOSB |_| VOSB |_| SB |_|

Offering Entity Currently Certified in SAM under NAICS 531120 as defined at FAR 52.219-1 Small Business Program Representations |_| Offering Entity Currently Verified in VetCert: YES |_| NO |_| N/A |_|

____________________________________
Offering Entity POC SignatureDate

Offering Entity POC Name

File details come from the government source that posted it. Updated .