SOURCES SOUGHT_CONTRACTOR FORM.docx

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Attached to
9905--MD | KC VAMC | VHA SIGNAGE PROGRAMMING | (VA-27-00007248)
Solicitation number
36C25527Q0039
Issued by

About this file

This is a Sources Sought Contractor Information Form template used by the Network Contracting Office 15 to collect general information from potential contractors interested in federal contracting opportunities.

The form requests basic contractor identification including business name, address, SAM UEI, and point of contact details. It requires contractors to identify their business type by selecting from various small business certifications (SBA 8(a), HUBZone, Service-Disabled Veteran-Owned, Veteran-Owned, Women-Owned, and Economically Disadvantaged Women-Owned), or indicating if they are a large business. The form also requests contractors to document the number of projects completed at various contract value ranges, with a specific line item for projects valued at $5 million and above. Additionally, contractors are instructed to provide a capabilities statement limited to one page. The form includes a text box at the bottom for clarifying any requested information. This is a template document designed to standardize contractor information collection and does not contain specific solicitation requirements, timelines, or award criteria.

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Text version

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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