Response template MODIFIED1.doc

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Defense Security Service

Telecom Response Template

RFQ HS0021-12-Q-0049 Fairview Heights, IL

General Information

Business Name

DUNS#

Addresss:

City: State: Zip:

Experience doing tasks in the SOW: Years Months

Equipment is 508 compliant: [ ]Yes [ ] No Where can 508 information be found: attached URL:

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

Specific Experience ( )

Agency or Business:

Contract Number:

Period of Performance:

Narrative of Work Accomplished:

Name of Person familiar with your performance:

Position within the entity:

Telephone: Email:

Specific Experience (2)

Narrative of Work Accomplished:

Name of person familiar with your performance:

Position wihin the entity:

Telephone Number:

Email:

Specific Experience (2)

Narrative of work Accomplished:

Name of Person familiar with your performance:

Position within the entity:

Telephone Number:

Email:

NOTE* 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 Solution Summary:

Basic Solution: [ ] Centrex, [ ] PBX [ ] Other

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

If PBX, Make & Model:

**Make and Model of Phones:

Number of phones provided:

If PRI included, how many:

DID for every phone: [ ] Yes [ ] No . If not, how may:

Digital or Analog system but VOIP Capable: [ ] Yes [ ] No

[ ] Analog [ ] Digital . Any BRIs? [ ] YES [ ] NoHow many BRIs:

Confirm alarm, Fax, and BRI lines not running thru PBX: [ ] Yes [ ] No

Local Carrier:

Long Distance Carrier:

Billing & Payment

Note: ** 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.

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

[ ] Amendment 0001 Title:

[ ] Amendment 0002 Title:

[ ] Amendment 0003 Title:

[ ] Amendment 0004 Title:

Terms and Conditions:

[ ] Agree to all terms and conditions as stated in the RFQ

[ ] Certified to maintain the system offered.

Submission Checklist

[ ] Telecom Response Template

[ ] Telecom Response Pricing Summary Template

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

[ ] Warranty

[ ] 508 information �Inserted this line.