Exhibit M Offering Entity Acknowledgement Form.pdf

115 KB Posted

Attached to
X1DB--Amendment to Extend Submission Deadline
Solicitation number
36C25025R0020
Issued by

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The document is an Offering Entity Acknowledgement form for RLP Number 36C25025R0020, associated with a Department of Veterans Affairs lease solicitation for a Community Based Outpatient Clinic (CBOC) in Georgetown/Mt. Orab, Ohio. The form requires potential offerors to provide comprehensive entity information, including unique identifiers, contact details, and business status, with specific emphasis on small business and veteran-owned business certifications.

Key requirements include completion of fields such as Entity Name, SAM UEI, DUNS Number, Tax ID, Authorized Official details, and verification of SAM and VetCert status. The solicitation is set-aside for Service-Disabled Veteran Owned Small Businesses (SDVOSB), targeting a lease of 11,241 ABOA square feet and sixty parking spaces. Offerors must accurately complete all sections, with a warning that incomplete information may render the proposal non-responsive. The form provides checkboxes for entity size status (SDVOSB, VOSB, SB) and requires an authorized point of contact signature and date of submission.

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36C25025R0020 0002_1.pdf PDF
36C25025R0020 0001.pdf PDF
36C25025R0020 0001_1.docx DOCX document
GEORGETOWN AMENDMENT 1 EXHIBIT A.pdf PDF
Exhibit O AbilityOne Certification Form.pdf PDF
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Exhibit I GSA Form 12000 for Prelease Fire Protection and Life Safety Evaluation for an Office Building Part A Part B.pdf PDF
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Exhibit P FAR 52.204-24 and 52.204-26.pdf PDF
Exhibit N Past Performance Questionaire.pdf PDF
Exhibit K Security Unit Price List FSL II.xlsx XLSX spreadsheet
Exhibit J Master TICS Table.xlsx XLSX spreadsheet
Exhibit A 36C25025L0010.pdf PDF
RLP 36C25025R0020 Georgetown Mt Orab Clinic.pdf PDF
Exhibit G Form 1364 Proposal to Lease Space Jan 2023.pdf PDF
Exhibit E 3516 Solicitation Provisions Dec 2023.pdf PDF
Exhibit D Facility Security Level II.pdf PDF
Exhibit H GSA1217-16e.pdf PDF
Exhibit F 3517B General Clauses Dec 2023.pdf PDF
Exhibit C Conceptual Floor Plan and PFD.pdf PDF
36C25025R0020_1.docx DOCX document
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Offering Entity Acknowledgement for RLP Number: 36C25025R0020 Georgetown/Mt. Orab CBOC

The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No.: 36C25025R0020. 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

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