Exhibit L - Offering Entity Acknowledgement Form.pdf
PDF 165 KB Posted
- Attached to
- X1AA--Oscoda CBOC - Amendment 2 Question
- Solicitation number
- 36C25024R0208
About this file
The document is an Offering Entity Acknowledgement Form for a Request for Lease Proposals (RLP) with solicitation number 36C25024R0208, issued by the Department of Veterans Affairs Veterans Health Administration for the X1AA--Oscoda CBOC (Community-Based Outpatient Clinic) New/Replacing Lease. The form requires potential offerors to provide detailed company information, including entity name, address, UEI number, tax identification number, and authorized official contact details, with options to indicate business size status such as Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), Small Business (SB), or Large Business.
The form mandates that offerors attest to the accuracy of their submitted information, which will be used as a basis for evaluation. Failure to provide required information may result in the proposal being deemed non-responsive. The document includes checkboxes for confirming the authorized official's listing in Entity SAM Representations and Operating Agreement, with a specific section for veteran-owned businesses to verify their current status in VetCert. The form is part of a comprehensive solicitation package for a lease opportunity in Oscoda, with multiple exhibits covering various aspects of the procurement process.
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Text version
REQUEST FOR LEASE NETWORK CONTRACTING OFFICE 10
PROPOSALS (RLP) Exhibit: ____
Offering Entity Acknowledgement for RLP No.: _______________________
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No.: _______________________. Failure to provide the required information may result in your proposal being deemed non-responsive.
Offeror Information
Offering Entity Name: __________________________________ Address: __________________________________ Offering Entity UEI Number: ________________________ Offering Entity Tax Identification No.: ________________________ 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
LARGE BUSINESS
Offering Entity Currently Verified in VetCert **This block only pertains to offerors who are Service-Disabled Veteran-Owned Small Businesses or Veteran-Owned Small Businesses.
Offering Entity POC Signature Date
Offering Entity POC Name
| Exhibit: L |
| Offering Entity Tax Identification No 1: |
| Offering Entity Tax Identification No 2: |
| Authorized Official Phone Number 1: |
| Authorized Official Phone Number 2: |
| Time Specified for Receipt of Offers: |
| VOSB: Off |
| SB: Off |
| LARGE BUSINESS: Off |
| Offering Entity Currently Verified in VetBiz: Off |
| Offering Entity POC Name: |
| RLP: 36C25024R0208 |
| Name: |
| Address: |
| UEI No: |
| Date: |
| SDVOSB: Off |
| Yes1: Off |
| Yes2: Off |
| No2: Off |
| No1: Off |
File details come from the government source that posted it. Updated .