Exhibit N-36C25026R0006 Offering Entity Acknowledgement Form.pdf
PDF 301 KB Posted
- Attached to
- X1DB--Kalamazoo Clinic RFI Response #4
- Solicitation number
- 36C25026R0006
About this file
This is an Offering Entity Acknowledgement form for a Request for Lease Proposals (RLP) issued by Network Contracting Office 10 under solicitation number 36C25026R0006. The form serves as a template for offerors to submit required company and authorized official information for evaluation purposes.
The form requires offerors to provide their entity name, address, Unique Entity Identifier (UEI) number, tax identification number, and authorized official contact details including name, phone number, and email address. Offerors must also confirm whether their authorized official is listed in the entity's SAM (System for Award Management) representations and operating agreement. The form includes fields for submission date and time of receipt, and requires offerors to identify their business size status by selecting one of four categories: Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), Small Business (SB), or Large Business. The form concludes with signature and date lines for the offering entity's point of contact. This is a template document designed to standardize the collection of offeror information and acknowledgment of accuracy for lease proposal evaluations.
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Text version
REQUEST FOR LEASE NETWORK CONTRACTING OFFICE 10
PROPOSALS (RLP)
Offering Entity Acknowledgement for RLP No.: 36C25026R0006
The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No.: 36C250260006 .
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 POC Signature Date
Offering Entity POC Name
Exhibit: N
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