Attachment_3_-_Offeror's_Information_Form.docx

DOCX document 12 KB Posted

Attached to
Patient Safety Specialist Services Federal contract opportunity
Solicitation number
N62645-19-R-0005
Issued by
Department of the Navy Bureau of Medicine and Surgery

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Attachment 3

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Other files attached to Patient Safety Specialist Services, newest first.
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Amendment_1_N62645-19-R-0005.docx DOCX document
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Attachment_5_-_Establish_U.S._Citizenship.docx DOCX document
Attachment_4_-_Pricing_Workbook_for_N62645-19-R-0005.xlsx XLSX spreadsheet
N62645-19-R-0005.docx DOCX document
Attachment_1_-_Past_Performance_Information_Sheet.docx DOCX document

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Attachment 3—Offeror’s Information Form Provide two points of contact. The points of contact shall be officials from the prime contractor or a member of the joint venture.

Company Name: _____________________________________________ CAGE Code: _____________________

DUNS: _________________________

TIN: ___________________________

Contact 1 Name: ____________________________________ Title:______________________________________ Phone Number: _____________________________ Email Address: _____________________________

Contact 2 Name: ____________________________________ Title:______________________________________ Phone Number: _____________________________ Email Address: _____________________________

I acknowledge that all items contained in the proposal submitted under solicitation N62645-19-R-0005 are true and accurate to the best of my knowledge. I also acknowledge receipt of all amendments to the solicitation.

Printed Name/Title: _____________________________________________

Signature/Date: ________________________________________________

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