RFP HT941026R2001- Certification Form - Amendment 4.docx
DOCX document 23 KB Posted
- Solicitation number
- HT941026R2001
- Issued by
-
Defense Health Agency
About this file
This is an RFP Certification Form for solicitation HT941026R2001 that contractors must complete and submit as part of their proposal package. The form requires offerors to provide standard company information including name, address, telephone number, CAGE Code, SAM Unique Entity Identifier (UEI), and point of contact details. Contractors must indicate which of the five required attachments are being submitted: Performance Work Statement (PWS), Past Performance Questionnaire, Past Performance Summary Sheet, Pricing Worksheet, and Incumbent Information & Site Specific Information.
The certification form includes two key acknowledgments that offerors must sign. First, the contractor must certify that they have thoroughly reviewed the Combined Synopsis/Solicitation and all accompanying documents, including the original solicitation and all amendments, and that they understand and accept any changes made during the solicitation process. Second, the contractor must acknowledge their willingness to hold prices firm for at least 180 days from the date specified for receipt of offers. This form serves as the offeror's formal commitment to the terms and conditions outlined in RFP HT941026R2001 for the Defense Health Agency's Integrated Referral Management and Appointing Center (IRMAC) Services contract, an 8(a) set-aside requirement with a NAICS code of 561110 and estimated award date of 30 September 2026.
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Text version
REQUEST FOR PROPOSAL (RFP) CERTIFICATION FORM
RFP number
Offeror’s name
Address
Telephone Number
CAGE Code
SAM Unique Entity Identifier (UEI)
Point of Contact
Please indicate which attachments are being submitted:
Type of Attachment
☐ Attachment 1– Performance Work Statement (PWS)
☐ Attachment 2- Past Performance Questionnaire
☐ Attachment 3– Past Performance Summary Sheet
☐ Attachment 4–Pricing Worksheet
☐ Attachment 5–Incumbent Information & Site Specific Information
Proposal Certification Form
I, [the contractor], hereby acknowledge that I have thoroughly reviewed the Combined Synopsis/Solicitation and all accompanying documents. These materials are based on the original solicitation and all amendments.
By signing this acknowledgment, I affirm that I understand and accept any changes made during the solicitation process. This includes amendments, clarifications, and updates related to the RFP.
Should any discrepancies arise, I commit to addressing them promptly and in accordance with the terms outlined in the proposal.
| ___________________________________ | |
| Name | Date |
| Contractor Organization |
I, [the contractor], hereby acknowledge that we are willing to hold prices firm for at least 180 days from the date specified for receipt of offers.
| _______________________________ | ||
| Name | Date | |
| Contractor Organization |
File details come from the government source that posted it. Updated .