J11_OFCCP_EEOC_Clrnc_Req.doc
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- C2F Mx & Repair Bldg 1000
- Solicitation number
- FA4600-16-R-0010
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J11 - DOL OFCCP EEOC Clearance Request Information Form
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Text version
FA4600-16-R-0010
Attachment 11
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:
| System for Award Management (SAM) |
| Cage Code: |
DUNS number
Vendor name as it appears in SAM:
Physical address as it appears in SAM:
| 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 three |
| $ |
| Option year one |
| $ |
| Option year four |
| $ |
| Option year two |
| $ |
| Six-month Extension |
| $ |
| 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 |
File details come from the government source that posted it. Updated .