Information_Request_Form.docx

Sources Sought Information Request Form

Project Name: Notification and Warning System Equipment NAICS Code: 334310, Audio and Video Equipment Manufacturing Small Business Size Standard: 750 Employees

Interested firms please respond with this information form and the following requested information. Please complete all sections of the document.

1. Company Information:

Company name: _________________________________________________________________ Company Address:________________________________________________________________________

( ) I have confirmed that the company name and address listed above is exactly the same as listed in (SAM) ( ) The above company name and address is not the same in (SAM), but registration is being corrected to the above listed address ( ) The above company name and address is not registered in (SAM), but registration will be completed if a quote is submitted in response to Request for Quote (RFQ) solicitation.

( ) The above company intends to bid on referenced project as a prime contractor.

DUNS Number: ________________________________

Socio-economic status for the listed NAICS code - please check all that apply:

( ) Service-Disabled Veteran-Owned Small Business (SDVOSB)

The firm must be registered in System for Award Management (SAM) https://www.sam.gov/portal/public/SAM/ with the socio-economic status identified above and the NAICS code specified in the sources sought notice. If the firm’s (SAM) record does not include this project’s NAICS code, the firm will not be considered.

( ) I have confirmed that my firm is registered in SAM for the NAICS code and business type selected ( ) My firm is not registered in SAM with the NAICS code and business status selected, but the firm qualifies and registration is in process ( ) My firm is not registered in SAM for the identified NAICS code

2. Examples of similar work:

( ) I have attached three references for similar work that our firm has performed.

( ) I have not attached three references of similar work that our firm has performed.

Certification:

I understand that incomplete answers in sections or my failure to provide required documentation or failure to sign this certification may remove my firm from consideration for this project sources sought notice.

Signature:_____________________________________________ Name: ________________________________________________ Title: ________________________________________________ Phone Number: _______________________