Intention to propose_11R00002.pdf

Vendor Name:

Type of Business:

Point of Contact:

Phone Number: Zip Code:

Fax Number:

E-mail:

Address Line 1:

Address Line 2: Zip Code:

YES NO

YES NO

City:

Size of Business:

State/Province:

Own Land and Facility Lease Land and Facility

New Construction

Address Line 2:

County/Region:

State/Province:

Proposed Facility Location

City:

Intention to Propose: HSCEDM-11-R-00002

(Large/Small/SDB, etc.)

Registered NAICS:

NEPA Phase 1 Study Completed:

DUNS Number: CAGE Number:

Vendor Services

Address Line 1:

Additional Comments/Information:

Existing Facility

Offerors are requested to provide the completed form for informational purposes only. Offerors who submit the form are not obligated to submit a proposal, and offerors that do not submit the form are not prohibited from proposing.

Send completed form by email to al.kidd@dhs.gov or fax to 949-360-3013 Attention: Al Kidd

Modified Existing Facility

CCR Registration:

file name: Vendor Response Form_03-2011.xls mailto:al.kidd@dhs.gov�

Sheet1