Attachment_7_Office_of_Federal_Contract_Compliance_Form.docx

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Attachment 7 Office of Federal Contract Compliance Programs (OFCCP) Form

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ATTACHMENT 10

DOL OFCCP EEOC Clearance Request Information Form Complete for each vendor with prime or subcontractor status in subject proposal

VENDOR IDENTIFICATION
Prime Contractor
Yes No
Subcontractor
Yes No

Full name of vendor:

System for Award Management (SAM)
Cage Code:

DUNS number

Vendor name as it appears in SAM:

Physical address as it appears in SAM:

CONTRACT PERFORMANCE
List place(s) of performance with reference to subject proposed work
Place(s) of Performance:
Number of employees at this site:
Previous Government contracts performed from this site:

Yes No

Yes No

Yes No

Yes No

POINT OF CONTACT

Point of contact for DOL EEOC clearance issues

Name and title

Telephone and fax numbers

Email address

PROPOSED AWARD AMOUNTS

List proposed award amounts

Base year
$
Option year five
$
Option year one
$
Option year six
$
Option year two
$
Option year three
$
Option year four
$
Total base plus all option periods award amount
$
CORPORATE AFFILIATES
List the name, address, POC and telephone number of all corporate affiliates
1
4
2
5
3
6

Sec J, Atch 15

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