Exhibit M Offering Entity Acknowledgement Form.pdf

Offering Entity Acknowledgement for RLP No. 36C25023R0141 Down River, Michigan CBOC

The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. 36C25023R0141. 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 Signature Date

Offering Entity POC Name