Comb_SS_Response_page.pdf

Solicitation

RESPONSE PAGE

RETURN THIS PAGE WITH THE COMPLETED INFORMATION AND AUTHORIZED SIGNATURE

1. OFFEROR INFORMATION

BUSINESS NAME:

STREET ADDRESS: CITY, STATE, ZIP:

CAGE CODE and DUNS: SAM REGISTRATION DATE:

BUSINESS WEB ADDRESS: SOCIOECONOMIC STATUS:

POINT OF CONTACT (POC): POC TITLE:

TELEPHONE: FAX:

E-MAIL:

2. Supplies/Services and Prices/Costs

CLIN 0001 Proposed Price: Unit/EA Price: $_______ Total Price for CLIN 0001: $____________

Total Proposed Price for all CLINs: $__________

DISCOUNT TERMS:

NET 30 or _______% IN _______ DAYS

DAYS REQUIRED FOR DELIVERY:

3. Certification of Response

Offeror’s Authorized Representative's Signature Date

Type or Print Name Position or Title

Contractor is required to sign this document and return 1 copy to issuing office. Contractor agrees to furnish and deliver all items set forth or otherwise identified above and on any additional sheets subject to the terms and conditions specified herein.