Section J Attachment 15 - DOL EEOC Clearance Request Information Form.doc
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- FA4600-11-R-0009
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DOL OFCCP EEOC Clearance Request Information Form
Complete for each vendor with prime or subcontractor status in subject proposal
| VENDOR IDENTIFICATION |
| Prime Contractor |
| Yes No |
| Subcontractor |
| Yes No |
Full name of vendor:
| Central Contractor Registration (CCR) |
| Cage Code: |
DUNS number
Vendor name as it appears in CCR:
Physical address as it appears in CCR:
| CONTRACT PERFORMANCE |
| List place(s) of performance with reference to subject proposed work |
| Place(s) of Performance: |
| Number of employees at this site: |
| Previous Government contracts performed from this site: |
Yes No
Yes No
Yes No
Yes No
POINT OF CONTACT
Point of contact for DOL EEOC clearance issues
Name and title
Telephone and fax numbers
Email address
PROPOSED AWARD AMOUNTS
List proposed award amounts
| Base year |
| $ |
| Option year five |
| $ |
| Option year one |
| $ |
| Option year six |
| $ |
| Option year two |
| $ |
| Option year three |
| $ |
| Option year four |
| $ |
| Total base plus all option periods award amount |
| $ |
| CORPORATE AFFILIATES |
| List the name, address, POC and telephone number of all corporate affiliates |
| 1 |
| 4 |
| 2 |
| 5 |
| 3 |
| 6 |
Attachment 15: DOL, EEOC Clearance Request Information Form
File details come from the government source that posted it. Updated .