Attachment_L-1_(FA890313R0002_Contractor_Data_Form)_3DEC2012.docx

POST CLOSING MANAGEMENT 2013

ATTACHMENT L-1: CONTRACTOR DATA FORM

3 DEC 2012

Contact Information Program Manager

First Name:

Last Name:

Email:

Phone:

Company/Division Information Company Name:

Division:

Address/Line 1:

Address/Line 2:

County:

Telephone:

Fax:

CAGE Code:

DUNS:

TIN:

Type of Business:

Small Disadvantaged Business?

Women Owned Small Business?

HUB Zone Small Business?

Service Disabled Veteran Owned Small Business?

Veteran Owned Small Business?

PRIMARY Basic Negotiate/Obligate POC Title:

First Name:

Last Name:

Address/Line 1:

Address/Line 2:

Telephone:

Mobile Phone:

Fax:

Email:

ALTERNATE Basic Negotiate/Obligate POC Title:

First Name:

Last Name:

Address/Line 1:

Address/Line 2:

Telephone:

Mobile Phone:

PRIMARY Task Order Recipient to receive RFP Packages

First Name:

Last Name:

Address/Line 1:

Address/Line 2:

Telephone:

Mobile Phone:

Fax:

Email:

ALTERNATE Task Order Recipient to receive RFP Packages Title:

First Name:

Last Name:

Address/Line 1:

Address/Line 2:

Telephone:

Mobile Phone:

Fax:

Email:

PRIMARY Task Order Negotiate/Obligate Point of Contact Title:

First Name:

Last Name:

Address/Line 1:

Address/Line 2:

Telephone:

Mobile Phone:

ALTERNATE Task Order Negotiate/Obligate Point of Contact

First Name:

Last Name:

Address/Line 1:

Address/Line 2:

Telephone:

Mobile Phone:

Fax:

Email:

Defense Contract Audit Agency General Information DCAA Code:

Address/Line 1:

Address/Line 2:

Telephone:

Fax:

Teaming Partners

PCM-13

FA8903-13-R-0002

Attachment L-1