SOURCES SOUGHT_CONTRACTOR FORM.docx

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J059--PNEUMATIC TUBE SYSTEM PM&R SERVICES HARRY S TRUMAN VA MEDICAL CENTER COLUMBIA, MISSOURI
Solicitation number
36C25527Q0007
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About this file

This is a Sources Sought Contractor Information Form template issued by the Network Contracting Office 15 of the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15. The form is designed to collect general contractor information for market research purposes related to a potential procurement for pneumatic tube system preventive maintenance and repair (PM&R) services at Harry S. Truman VA Medical Center in Columbia, Missouri.

The form requests contractor business information including name, address, SAM UEI, and point of contact details. It requires contractors to identify their business classification across multiple socio-economic categories, including SBA certified 8(a) firms, HUBZone small businesses, service-disabled veteran-owned small businesses (SDVOSB), veteran-owned small businesses, women-owned small businesses, economically disadvantaged women-owned small businesses, and large businesses. The government intends to set-aside this requirement for SDVOSB but is actively seeking responses from all qualified sources. The form also requests documentation of project experience at various funding levels, with a minimum threshold of $5 million noted. Responses to this sources sought notice are limited to one page and will be used solely for market research and acquisition planning purposes under NAICS 811310 and PSC J059, with no obligation on the government to conduct a competitive procurement or notify respondents of procurement decisions.

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36C25527Q0007_SSN.docx DOCX document
SOURCES SOUGHT_CONTRACTOR FORM_Fillable.pdf PDF

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SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

for

NETWORK CONTRACTING OFFICE 15

Use this form to provide contractor’s general information. Please limit response to one page. The box at the bottom of this form may be used to clarify any requested information.

1. Contractor Information:

Business Name:
Address:
SAM UEI:
Name of POC for Business:
Phone Number of POC:
Email of POC:

2. Type of Business: (check all that apply)

|_| SBA certified 8(a) firm
|_| SBA certified HUBZone Small Business
|_| Service-Disabled Veteran-Owned Small Business
|_| Veteran-Owned Small Business
|_| Economically Disadvantaged Women-Owned Small Business
|_| Women-Owned Small Business
|_| Other: ___________________________
|_| Large Business
3. Please identify number of projects your organization has performed at the different ranges identified below:
<$500K______ $500K ~ $1M______
$1M ~ $2M______ $2M ~ $5M______
>$5m______

4. CAPABILITIES STATEMENT:

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