Telecom_Response_Template.doc

Defense Security Service

Telecom Response Template

RFQ HS0021-11-P-0059

General Information

Business Name:

DUNS:

Address:

City:

State:

Zip:

Experience doing tasks in the SOW: Years FORMDROPDOWN

Months FORMDROPDOWN

If over 25 years of experience, how many exactly?

Experience doing similar tasks for the Federal Government: Years FORMDROPDOWN

Experience doing similar tasks for DoD: Years FORMDROPDOWN

Managed Multiple locations for same entity: FORMCHECKBOX Yes FORMCHECKBOX No Equipment is 508 compliant: FORMCHECKBOX Yes FORMCHECKBOX No

Where can 508 information be found: FORMDROPDOWN

URL:

Specific Experience and Past Performance References (Note: DoD and Federal Government experience is considered more relevant) Specific Experience (1)

Agency or Business:

Contract Number:

Period of Performance:

Narrative of Work Accomplished:

Name of person familiar with your performance:

Position within the entity:

Telephone Number:

Email:

Specific Experience (2)

Period of Performance:

Specific Experience (3)

Period of Performance:

Solution Summary Basic Solution: FORMDROPDOWN

If you answered “Other” under basic solution explain below:

If PBX, Make & Model:

Make and Model of Phones:

Number of phones provided: FORMDROPDOWN

If PRI included, how many: FORMDROPDOWN

DID for every phone: FORMCHECKBOX Yes FORMCHECKBOX No If not, how many: FORMDROPDOWN

Digital or Analog system but VOIP Capable: FORMCHECKBOX Yes FORMCHECKBOX No

BRI: FORMCHECKBOX

Analog FORMCHECKBOX Digital How Many BRIs: FORMDROPDOWN

Confirm alarm, Fax, and BRI lines not running thru PBX: FORMCHECKBOX Yes

Local Carrier:

Long Distance Carrier:

Billing & Payment

Preferred Payment Method for Maintenance: FORMDROPDOWN

Acknowledgement of Amendments as of response date (If any):

FORMCHECKBOX

Amendment 0001 Title:

Amendment 0002

Amendment 0003

Amendment 0004

Terms & Conditions:

Agree to all terms and conditions as stated in the RFQ

Submission Checklist

FORMCHECKBOX

Telecom Response Template

FORMCHECKBOX

Telecom Response Pricing Summary Template

FORMCHECKBOX

Representations & Certifications Template (Note: Even if vendor has an Orca record the vendor must fill out section b of the document and submit it. In addition, if the total award (including all options) is expect to exceed $150,000, the vendor must fill out the DoD representations and certifications at the end of the template.)

FORMCHECKBOX

Warranty Information

FORMCHECKBOX

508 information � If this question is answered affirmatively, then list this work as one of your experience/past performance references. If the work of managing multiple offices for a single entity involves multiple contract numbers enter “multiple” instead of an actual contract number.

� If more than one model of phone is offered, list the make and model of the phone and the number of the phones offered in that make and model. For example, Toshiba X-Ray (8) and Toshiba K-Ray (10). List the total number of phones in the “Number of phones provided” blank irrespective of the model.

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