Exhibit P Offering Entity Acknowledgement Form.pdf

114 KB Posted

Attached to
X1DB--Howard City CBOC
Solicitation number
36C25023R0103
Issued by

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This document contains an acknowledgement form and details of a related federal contract opportunity for the construction of a Community Based Outpatient Clinic in Howard City, Michigan. The acknowledgement form requires the offering entity to provide identifying information including their name, address, unique entity identifier, DINs number, tax ID, and authorized official contact details. It also requires the entity to attest to their size status as a SDVOSB, VOSB, or SB, and their current SAM and VetCert verification status. The related federal contract opportunity is solicitation number 36C25023R0103 issued by the Department of Veterans Affairs Veterans Health Administration VISN 10 for the construction of the Howard City CBOC. No further details are provided on requirements, response dates, or award information.

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Offering Entity Acknowledgement for RLP No.: 36C25023R0103 Howard City, MI CBOC

The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No.: 36C25023R0104. 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 .