SOURCES SOUGHT_CONTRACTOR FORM_Fillable.pdf
PDF 230 KB Posted
- Attached to
- S201--MC | MA VAMC | EVERGLAZE FLOOR MAITENANCE
- Solicitation number
- 36C25526Q0118
About this file
This document is a Sources Sought – Contractor Information Form for the VHA (Veterans Health Administration) | RPOC (Regional Procurement Operations Center) | Network Contracting Office 15. The form is designed for potential contractors to provide their business details and capabilities. It includes sections for basic company information, business type classification (with options for small business certifications like 8(a), HUBZone, Veteran-Owned, and Women-Owned), and a breakdown of previous project experience across different contract value ranges (from <$500K to >$5M). The form requires contractors to list their SAM (System for Award Management) Unique Entity Identifier (UEI) and provides a space for a capabilities statement, allowing businesses to showcase their qualifications for potential contract opportunities within the VHA procurement system.
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Other files
| File | Type | Posted |
|---|---|---|
| SOURCES SOUGHT_CONTRACTOR FORM.docx | DOCX document | |
| 36C25526Q0118_SSN.docx | DOCX document |
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Text version
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 #: |
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