Attachment_10_-_EEOC_Clearance_Request.pdf

FA9451-15-R-0029

EEOC Clearance Request Information Form

Attachment 10

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