Attachment_2_-_RFQ_Information_Sheet.doc

NARA-NAMA-16-Q-0041 – Portable Suction Tables

ATTACHMENT 2

RFQ Information Sheet

Failure to provide the TAA Country of Production (if applicable) may result in no further consideration of the quotation. Contractors must complete this sheet and submit it with their quotation. Failure to do so may render the quotation unacceptable for receipt of the order.

Statutory/Regulatory Compliance

TRADE AGREEMENT ACT COUNTRY OF PRODUCTION:_____________________

ENERGY STAR® OR FEDERAL ENERGY MANAGEMENT PROGRAM (FEMP)

ENERGY USE REQUIREMENT COMPLIANCE, AS REQUIRED: YES_____ or NO_____

IPv6 COMPLIANT: YES____ or NO_____

SECTION 508 COMPLIANT: YES_____ or NO____

Specific Terms, Conditions, and Administrative information

PAYMENT TERMS:

DELIVERY DATE:

WARRANTY: __________________________________________________________

NAME AND ADDRESS OF QUOTER:

TELEPHONE NO (INCLUDE AREA CODE): __________________________

FAX NUMBER: ___________________________

E-MAIL ADDRESS:

ENROLLED IN SYSTEM FOR AWARD MANAGEMENT (SAM)? Yes____ No____

CAGE CODE NUMBER: _____________________________________

DUNS: _______________________________________

Vendor Certification: [By signing the Contractor acknowledges that the information provided in response to this RFQ is correct.]

NAME AND TITLE OF SIGNER: __________________________________

DATE OF QUOTATION: ___________________________________

SIGNATURE OF PERSON AUTHORIZED TO SIGN: ______________________________