Exhibit Q - Lusaka.docx

EXHIBIT Q – OFFER INFORMATION AND/OR JOINT VENTURE SIGNATURE PAGE

Offeror must complete form as applicable, please type information.

Legal Business Name of Entity Submitting Offer:

Mailing Address: (Street Address)

(City, State, Zip Code)

(Country)

Year Established

Website:

DUNS Number:

Primary Offeror Point of Contact:

Phone Number Office & Cell:

Email Address:

*If Joint Venture, present a DUNS number above for the Joint Venture. Then, complete below as applicable for each joint venture partner (complete multiple copies of this form if necessary to include all partners):

Joint Venture Partner #1:

Legal Business Name:

DUNS Number:

Mailing Address: (Street Address)

(City, State, Zip Code)

(Country)

Website:

Point of Contact:

Phone Number:

Email Address:

Joint Venture Partner #2:

Legal Business Name:

DUNS Number:

Mailing Address: (Street Address)

(City, State, Zip Code)

(Country)

Website:

Point of Contact:

Phone Number:

Email Address:

Joint Venture Signature Page Solicitation Number S-AQMMA-11-0008 Contract Number S-AQMMA-11-C-XXXX U.S. Embassy Kigali

Joint Venture Name and Address:

Joint Venture Participants:

Company A (Co A), by

_____________________________________________ Date: _________________ Signature Name:

Title:

Company B (Co B), by

_____________________________________________ Date: _________________ Signature Name:

Title:

Company C (Co C), by

_____________________________________________ Date: _________________ Signature Name:

Title: