Attachment_A-Quote_Submission_(Pdf).pdf

ATTACHMENT A

HDEC05-17-R-0007, Page 1 of 7

OFFER SUBMISSION FORM

SOLICITATION NUMBER HDEC05-17-R-0007

(Please hand write, legibly, and scan as a .PDF file for submission)

Food Safety Manager Certification Exam at the Defense Commissary Agency, Headquarters

Fort Lee, Virginia

(1) Solicitation Number HDEC05-17-R-0007

(2) Offers are due no later than Friday, May 12, 2017, 12:00 NOON EST

(3) Name, address, point of contact, fax number, and telephone number of the offeror:

Company Name:

Address:

Point of Contact:

Fax:

Phone:

(4) To evaluate compliance with the requirements in the solicitation; ANSI certified, include proof of certification requirement. This may include product literature, or other documents, if necessary.

(Please keep this document to no more than 2 pages, using a12 point font, and 1 inch margins.);

(5) Price: Provide a total price for all 5 years (1 base year and 4 option years).

(6) Provide the per year price.

(7) Provide the per exam price.

Please note that quotes for all supplies & years must be provided to be considered for award:

Food Safety Manager Certification Exam Information including the following:

20 Each of Food Safety Manager Certification Exam 1 Each of White Exam Return Envelope 1 Each of Order Instruction Pages 1 Each of Exam Administrator's Manual

Base Year: May 22, 2017 through May 21, 2018

HDEC05-17-R-0007, Page 2 of 7

1 Each of White Exam Return Envelope 1 Each of Order Instruction Pages

1 Each of White Exam Return Envelope 1 Each of Order Instruction Pages

1 Each of White Exam Return Envelope 1 Each of Order Instruction Pages

1 Each of White Exam Return Envelope 1 Each of Order Instruction Pages

Any Applicable Discount Terms:

(8) “Remit to” address.

Remit to address is the same as (3) above

(9) Representations and certifications (FAR and DFARS) are current and available online through the System for Acquisition Management (www.SAM.gov).

Acknowledged

Fourth Option Year: May 22, 2021 through May 21, 2022

Third Option Year: May 22, 2020 through May 21, 2021

Second Option Year: May 22, 2019 through May 21, 2020

First Option Year: May 22, 2018 through May 21, 2019

HDEC05-17-R-0007, Page 3 of 7

(10) Acknowledgment of all Solicitation Amendments (if applicable).

Signed acknowledgment of all Solicitation Amendment(s) is/are attached.

N/A (No amendments published.)

(Please check FedBizOps for possible amendments before completing.)

(11) Reference information, to include the names, companies, and contact information (phone and email address) of at least three (3) individuals that can be asked to provide past performance information. References should represent previous work of similar scope to the requirements in this solicitation and should be current or prior customers (within the past 3 years).

Company:

Phone Number:

Alternate Phone Number:

Email Address:

Reference #3:

Reference #2:

Reference #1:

HDEC05-17-R-0007, Page 4 of 7

(12) A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation.

(13) Required Contractor Qualifications:

The contractor shall at all times during the contract period, maintain the following qualifications:

1. ANSI Accreditation

Yes No

2. Representations and certifications (FAR and DFARS) are current and available online through the System for Acquisition Management (www.SAM.gov).

(14) 252.209-7992 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID

DELINQUENT TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL

LAW—FISCAL YEAR 2015 APPROPRIATIONS (DEVIATION 2015-OO0005) (DEC 2014)

(a) In accordance with sections 744 and 745 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235), none of the funds made available by this or any other Act may be used to enter into a contract with any corporation that—

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless the agency has considered suspension or debarment of the corporation and made a determination that this further action is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless the agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that—

HDEC05-17-R-0007, Page 5 of 7

(1) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability,

(2) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

Proposal Signed and Submitted by:

SIGNATURE: DATE:

PRINTED NAME:

TITLE: