190502_Att_03_Proposal_Submission_Form_19R1538.pdf

Combined Synopsis/Solicitation (FAR 12.603 and FAR 5.207)

M67854-19-R-1538

Tropical Boot RFP

Attachment 3 – Proposal Submission Form

Company Information

Company Name

Cage Code Tax Payer ID DUNS Code

Street Address

City

State Zip Code

Phone Number

Fax Number Website

Business Type (e.g. Large, Small, 8(a), etc.) In Accordance With FAR 19.001, http://farsite.hill.af.mil/farsite.html)

Point of Contact Information

Point of Contact Name

Telephone Number Email Address http://farsite.hill.af.mil/farsite.html

M67854-19-R-1538

Price:

CLIN Description Quantity Unit of

Issue

Unit Price Total

Tropical Boot (Pre-Production

Samples)

100 Each $ $

0002 Tropical Boot 69,850

(maximum quantity)

Each $ $

0003 Tropical Boot Special Sizes 50 (maximum quantity)

Each $ $

0004 CDRLs Not

Seperately

Priced

M67854-19-R-1538

Tropical Boot RFP

Past Performance:

Past Performance Citation 1

Contract Number: Contract Type:

Total Contract Value: Period of Performance:

Customer/Agency:

Point of Contact (Name and email address):

Description of work, to include basis for relevancy to subject procurement:

M67854-19-R-1538

Past Performance Citation 2

Contract Number: Contract Type:

Total Contract Value: Period of Performance:

Customer/Agency:

M67854-19-R-1538

Tropical Boot RFP

Attachment 3 – Proposal Submission Form Past Performance Citation 3

Contract Number: Contract Type:

Total Contract Value: Period of Performance:

Customer/Agency:

M67854-19-R-1538

SB Participation Plan

Total

Small Business (SB) %

Small Disadvantaged Business (SDB) %

Woman-Owned Small Business (WOSB) %

HUBZone Small Business (HUBZone SB) %

Small Disadvantaged Veteran-Owned Small Business

(SDVOSB)

M67854-19-R-1538

Berry Amendment Self Certification

I, , in submitting this offer under solicitation number M67854-19-R-1538, affirm that only products compliant with the Berry Amendment (10 USC 2533a) will be delivered to the Government. As such, all items delivered, either as end products or components, will be grown, reprocessed, reused, or produced in the United States (as defined in DFARS 252.225-7012(b) included by reference herein). This certification covers all materials (including those of all components) and components supplied by subcontractors at any tier, and all labor (including that of all intervening processes), whether performed by the offeror or any of its subcontractors at any tier.

M67854-19-R-1538

The best value offer that conforms to the RFP may be selected for award. In order to be compliant and eligible for award, the Offeror must meet all solicitation requirements. No deviations will be accepted.

Discount Terms (NET 30 if unspecified):

FOB Destination Compliance (circle one):

YES NO (see FAR 52.247-34)

Carefully review all documents before signing

Offeror’s Authorized Representative's Typed or Printed Name Position or Title

Offeror’s Authorized Representative's Signature Date