Exhibit T- Offering Entity Acknowledgement Form.docx

DOCX document 39 KB Posted

Attached to
X1DB--Martinsville Consolidated Clinic- DRAFT Request For Lease Proposals (RLP)
Solicitation number
36C25024R0061
Issued by

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This document is an Offering Entity Acknowledgement Form for Request for Lease Proposals (RLP) No. 36C25024R0061 issued by the Department of Veterans Affairs (VA) for a consolidated clinic in Martinsville, Indiana. The VA is seeking 10,500 ANSI/BOMA Occupant Area square feet of contiguous space within a specified geographic area, with 40 secured and lit surface/outside parking spaces, 8 of which must be handicap accessible. The lease term is 20 years, 15 firm, with government termination rights. The VA may require use of part of the building roof for antenna installation. The offered space must meet federal and local requirements for fire safety, physical security, accessibility, seismic, and sustainability standards, and be compatible with the VA's intended use. The offeror must provide the requested information, including company details and authorized official, by the specified deadline to be considered responsive.

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Attachment G

Offering Entity Acknowledgement for RLP No.: 36C25024R0061 Martinsville, IN CBOC The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No.: 36C25024R0061. 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 SignatureDate

Offering Entity POC Name

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