Market Survey Blank Revised Form w NAME.docx

DEFENSE LOGISTICS AGENCY

LAND AND MARITIME

P.O. BOX 3990

COLUMBUS, OHIO 43218-3990

MARKET SURVEY QUESTIONNAIRE

Please Respond

THIS IS NOT A REQUEST FOR QUOTE

INFORMATION REQUIRED FOR PENDING REQUEST FOR PROPOSALS

Date:

To:

Cage:

NOTE: ITEM LISTED IS BEING CONSIDERED FOR SOLICITATION AND SUBSEQUENT AWARD.

PLEASE RETURN SURVEY BY COB

DLA Land & Maritime (Columbus) is considering a solicitation and subsequent Award on a Contract for the items below.

As a potential supplier of these items, we are asking that you fill out this market survey to the best of your knowledge so that we can generate a realistic and beneficial solicitation.

NOTE: This Contract may result in a Quantity Option.

Please indicate the absolute best delivery (in Days) you would be able to provide this item.

REQUIREMENTS:

P/N: 610645

PLEASE COMPLETE THE FOLLOWING:

The NAICS code for this item is: _ __ Please indicate below your business size for this NAICS code.

Please ensure that your SAM information and ORCA certifications reflect this NAICS code.

SAM website: https://www.sam.gov ORCA website: https://orca.bpn.gov/login.aspx

|_| Large Business / |_| Small Business

|_| Manufacturer / |_| Dealer

Are you the ACTUAL Manufacturer of the item? |_| Yes |_| No

Identify Source of Supply if Dealer: ___________________________________________________

Where is the item manufactured?

Company & CAGE:

City:

State:

Country:

1. Do you deal through dealer/distributors or do you prefer to deal directly with the Gov’t? |_| Dealer |_| Gov’t

2. Do you carry this item in your inventory? |_| Yes |_| No

3. Is this item quantity sensitive? |_| Yes |_| No

4. Is this a commercial item? |_| Yes |_| No

· NOTE: *You must complete or comply with the following if “yes”.

a. ______% sold to the general public / private sector.

b. ______% sold to the Government

c. Provide copy of the current Price List” available and is accessible to the general public.

d. Provide copies of recent “Invoices” to the general public.

e. Provide copy of the technical specification / data sheet(s) on the item to support your commercial claim.

f. If part of a higher assembly; provide the following:

i. Part Number & or NSN of the higher assembly.

ii. Copy of “Price List” available and accessible to the general public.

iii. Copies of “Invoices” to the general public.

iv. Copy of the technical specification / data sheet(s) on the item to support your commercial claim.

v. If item is commercial, will you comply with the solicitation clauses/

g. Requirements as specified in:

(1) FAR Part 12-Acquisition Of Commercial Items? [ ] yes [ ] no

(2) FAR Part 15-Contracting Negotiation (non-commercial clauses)? [ ] yes [ ] no

h. Please provide any additional data with your survey response to support your claim.

5. Are these commercial off the shelf items with commercial sales history? |_| Yes |_| No

6. Are these catalog/price listed items? |_| Yes |_| No

7. Are you able to supply us with a copy of your price list? |_| Yes |_| No

8. If “NO” to #4; are these items modified items of a type available in the commercial market place? |_| Yes |_| No

9. If “NO” to #8; do these items have minor modifications of a type not customarily available in the commercial

10. If “NO” to #4 & if these are not currently in the commercial market place; will these items be available in the commercial market place in time to satisfy the gov’t delivery requirements on this project? |_| Yes |_| No

11. Does this item contain hazardous material? |_| Yes |_| No

12. Can you provide STD-COM Pkg I/A/W ASTM D 3951 and provide/comply with RFID? |_| Yes |_| No

13. If "NO" to #12, are you currently in the process of obtaining the facilities to comply with RFID? |_| Yes |_| No

14. Is your company interested in pursuing a Firm Fixed Price Contract for the above item? |_| Yes |_| No

16. What is your approximate delivery for this item: ________________________________________

17. The Government prefers to utilize F.O.B. Origin; is this acceptable? |_| Yes |_| No

18. Do you have a minimum order? |_| Yes |_| No

19. Do you offer quantity/price breaks for this item and if so, please provide below:

20. Are there any salient features/cost driving factors or any materials, metals, etc.

that are dominant in this item? |_| Yes |_| No

*If “yes”, please provide the applicable process and/or state what percentage of that process/material. Please be specific: ___________________________________________________

21. What is the approximate unit size and weight of this item?

COMMENTS: _________________________________________________________________________________

Name/Signature: _______________________________________________

Phone Number: ________________________________________________

We Sincerely Appreciate Your Time, And Thank You For Providing This Information.

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