Attach_1_-_Contractor_Submittal_Form.docx
DOCX document 21 KB Posted
- Attached to
- FA2517-18-Q-5039 B404 HVAC Federal contract opportunity
- Solicitation number
- FA2517-18-Q-5039
About this file
Attach 1 - Contractor Submittal Form
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| RFQ_Repair_HVAC_Bldg_404_Amend_2.docx | DOCX document | |
| SOW_Bldg_404_HVAC-062918.docx | DOCX document | |
| RFQ_Repair_HVAC_Bldg_404.docx | DOCX document | |
| Attach_2_-_SOW_Bldg_404_HVAC_dated_21_Jun_2018.docx | DOCX document | |
| Attach_4_-__Drawings.pdf | ||
| Attach_3_-_Equipment_List.xlsx | XLSX spreadsheet |
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Text version
FA2517-17-Q-5044
FA2517-17-Q-5044
FA2517-18-Q-5039
Attachment 1 Contractor Submittal Form
RFQ# FA2517-18-Q-5039
Please complete the following:
| 1 |
| Contractor Name |
| 2 |
| DUNS Number |
| 3 |
| CAGE Code |
| 4 |
| NAICS Code (Must match para. 1 of the RFQ and offeror must be registered in SAM under this NAICS in order to be considered responsive) |
| 238220 |
| 5 |
| Point of Contact |
| 6 |
| Address |
| 7 |
| Phone Number |
| 8 |
| Email address |
| 9 |
| Payment Terms (Net 30 unless any discount terms are offered) |
| 10 |
| [Contractor Name]: |
CLIN Information
| CLIN |
| Supplies |
| Extended Item Description |
| Qty |
| Unit |
| Unit Price ($) |
| Total Amount ($) |
| 0001 |
| Gas Fired duct heater and blower unit |
| 1 |
| EA |
| 0002 |
| Exhaust Fans |
| 2 |
| EA |
| 0003 |
| Energy Management Control System sensors and tie ins |
EA
| 0004 |
| Source removal Duct Cleaning |
EA
Total Price
** Delivery & Installation shall be completed within 90 days after contract award. Peterson Air Force Base (PAFB), Colorado Bldg 404. All information described in Statement of Work, dated 21 June 2018. Include all shipping costs (if applicable) in the total amount quoted.
Offeror to complete the following:
DFARS 252.209-7999, Representation by Corporations Regarding an Unpaid Delinquent Tax Liability or a Felony Conviction under any Federal Law (Class Deviation 2012-O0004) (January 23, 2012)
(a) In accordance with sections 8124 and 8125 of Division A of the Consolidated Appropriations Act, 2012, (Pub. L. 112-74), none of the funds made available by this or any other Act may be used to enter into a contract with any corporation that-
(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless the agency has considered suspension or debarment of the corporation and made a determination that this further action is not necessary to protect the interests of the Government; or
(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless the agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.
(b) The Offeror represents that-
(1) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability,
(2) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.
(End of provision)
Company Name
Name
Title
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