Sources Sought Form 04JAN21.pdf

Sources Sought Response Form

NAICS Code: 562991 – Septic Tank and Related Services

Product Service Code: S205 – Housekeeping Trash / Garbage Collection

1. Company Information.

Company Name:

Company Address:

CAGE Code:

DUNS Number:

Socio-economic status for NAICS code 562991 - check all that apply:

( ) Large business ( ) Small business

( ) Small disadvantaged business ( ) 8(a) program participant

( ) HUB Zone business ( ) Woman-Owned business

( ) Service-Disabled Veteran-Owned Small Business (SDVOSB)

2. Areas Interested - check all that apply:

( ) Camp James A. Garfield Joint Military Training Center (CJAG), Ravenna, Ohio

( ) Camp Sherman Joint Training Center, Chillicothe, Ohio

( ) Rickenbacker Air National Guard Base (RANGB), Columbus, Ohio

( ) Camp Perry Joint Training Center, Port Clinton, Ohio

3. By responding to the Sources Sought Notice, I confirm that my firm is registered in the System for Award Management (SAM) https://www.SAM.gov/ with the socio-economic status identified above and the NAICS code specified in the sources sought notice; or that my firm qualifies and registration under the applicable NAICS code is in process.

Name:

Title:

Signature: