SOURCES SOUGHT_CONTRACTOR FORM_Fillable.pdf

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F115--Sources Sought Notice Spill Prevention Control and Countermeasures Plan (SPCCP) 5-year review Marion, IL VA Medical Center
Solicitation number
36C25526Q0066
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This Sources Sought - Contractor Information Form is issued by the VHA (Veterans Health Administration) | RPOC | Network Contracting Office 15 to gather potential contractor information. The one-page form requests details about a business's capabilities, including business type, project experience, and contact information. Contractors can indicate their business classification (such as 8(a), HUBZone, Service-Disabled Veteran-Owned, Women-Owned, etc.), and report the number of projects completed across different dollar value ranges from less than $500K to over $5M. There is also a section for a capabilities statement and a space for the contractor's System for Award Management (SAM) Unique Entity Identifier (UEI). The form appears to be a market research tool to identify potential sources for an upcoming procurement opportunity within the VHA contracting ecosystem.

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SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

for

VHA | RPOC | 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:

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:

SAM UEI:

Business Name:
Address 1:
Address 2:
Name of POC for Business:
Phone Number of POC:
Email of POC:
SBA certified 8a firm: Off
ServiceDisabled VeteranOwned Small Business: Off
Economically Disadvantaged WomenOwned Small Business: Off
Other: Off
undefined:
SBA certified HUBZone Small Business: Off
VeteranOwned Small Business: Off
WomenOwned Small Business: Off
Large Business: Off
3 Please identify number of projects your organization has performed at the different ranges identified below 500K 500K 1M 1M 2M 2M 5M 5m:
500K:
500K 1M:
2M 5M:
1M 2M 1:
1M 2M 2:
4 CAPABILITIES STATEMENT:
SAM UEI #:

File details come from the government source that posted it. Updated .