Attachment 3 Technical Capability Form (377MDG Laundry Service) (2-14-24).docx

HT940724Q0002 - Attachment (3) Technical Capability (2-14-2024) 377th Medical Group Laundry Service

GENERAL INFORMATION

Company Name: Click or tap here to enter text.

CAGE: Click or tap here to enter text.

Representative authorized to contractually obligate the company:

Name: Click or tap here to enter text.

Title: Click or tap here to enter text.

Phone Number: Click or tap here to enter text.

Email Address: Click or tap here to enter text.

1. Does your business have an active registration in the System for Award Management (SAM) at https://www.sam.gov?

☐ Yes ☐ No

2. Acknowledge each solicitation amendment by listing each one by number below (e.g., 0001, 0002, 0003, etc.). Note: A generic acknowledgement such as “we acknowledge all amendments” is not acceptable.

☐ I acknowledge the following amendments: Click or tap here to enter text.

☐ Not applicable – No amendments were issued.

3. “Remit to” address if Block 17b was checked on the SF 1449.

☐ Not applicable – Block 17b was not checked.

☐ Remit to address: Click or tap here to enter text.

4. The small business size standard for NAICS 812320 is $8.0M. Identify your business size for NAICS 812320. (Check all that apply) ☐ SBA Certified 8(a) Firm ☐ SBA Certified HUBZone ☐ Service-Disabled Veteran-Owned Small Business ☐ Veteran-Owned Small Business ☐ Disadvantaged Small Business ☐ Economically Disadvantaged Woman-Owned Small Business ☐ Woman-Owned Small Business ☐ HUBZone Small Business ☐ Small Business ☐ Other Type of Small Business (Specify): Click or tap here to enter text.

☐ Joint Venture ☐ Large Business

5. If you marked HUBZone Small Business in #4, please read 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns, carefully. Per paragraph (b), A HUBZone small business concern may elect to waive the evaluation preference, in which case the factor will be added to its offer for evaluation purposes. If you are a HUBZone Small Business, select one:

☐ Vendor elects to waive the evaluation preference.

☐ Vendor does not waive the evaluation preference.

6. The following required representations and certifications are current and complete as:

☐ ☐ FAR 52.204-24, Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment

☐ ☐ FAR 52.204-26, Covered Telecommunications Equipment or Services – Representation

☐ ☐ FAR 52.212-3 Alternate I, Offeror Representations and Certifications – Commercial Products and Commercial Services

☐ ☐ FAR 52.219-28, Post-Award Small Business Program Representation

☐ ☐ FAR 52.223-22, Public Disclosure of Greenhouse Gas Emissions & Reduction Goals – Representation

☐ ☐ DFARS 252.204-7016, Covered Defense Telecommunications Equipment or Services – Representation

☐ ☐ DFARS 252.204-7017, Prohibition on the Acquisition of Covered Defense Telecommunications Equipment or Services – Representation

TECHNICAL CAPABILITY

7. Does your company have experience performing medical laundry services like those required by the Performance Work Statement (RFQ Attachment 1)?

☐ No ☐ Yes

If yes, summarize up to three contracts during calendar years 2021 through 2023, including contract number, customer, location (city, state), total period performed, and total dollar value.

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8. Briefly detail your wash process and quality assurance for PWS paragraph 4.7, Special Wash, with focus on the biohazardous aspect of this requirement.

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9. Identify the physical address of the facility you will use to provide the required laundry services.

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10. Provide a statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Quotes that fail to furnish required information, or reject the terms and conditions of the solicitation, may be excluded from consideration. All exceptions taken to any terms and conditions stated in the solicitation must be clearly outlined here. The vendor also must include complete rationale, justification, and the price impact of each exception.

☐ This quote agrees to all terms, conditions, provisions, and requirements included in this solicitation; no exceptions taken.

☐ This quote includes the following exceptions to terms, conditions, provisions, and/or requirements included in this solicitation:

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11. Briefly provide any additional information your business would like DHA CMCD to consider.

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Signature of Representative Authorized to Obligate the Company:

Name, Title: Click or tap here to enter text. Date: Click or tap to enter a date.