Attachment_3-_Cover_Sheet.pdf

Cover Sheet

FA4417-19-R-0003

Perform Testing and Analysis at Advanced Wastewater Treatment Facility Hurlburt Field, FL

Time Specified for Receipt of Offer:

Company Name:

Company Affiliation (Circle One):

1. Prime Only

2. Prime & Subcontractor

3. Joint Venture

Small or Large Business:

Address(s):

Telephone Number(s):

E-mail(s):

Point of Contact(s):

SAM Registered Expiration Date:

CAGE Code:

DUNS Number:

Do your Representations and Certifications include NAICS code 541380 (Circle One): 1. Yes 2. No

Sign Here to Acknowledge Solicitation Amendments:

Solicitation FA4417-19-R-0003

Perform Testing and Analysis at Advanced

Wastewater Treatment Facility

Hurlburt Field, FL

1. Fill out all positions for Past Experience

Project title and contract number, to include POC name and phone number

Aggregate Dollar Amount and Period of Performance

Description of Service (specific testing and analysis performed)

Authorized Representative Signature