Sources Sought Information form.docx
DOCX document 16 KB Posted
- Attached to
- Medical and Dental Case Management Services
- Solicitation number
- W912PQ-22-Q-0035
About this file
This sources sought notice and related federal contract opportunity seek responses for medical and dental case management support services. The New York Army National Guard requires a contractor to perform lead non-clinical case management, medical records administration, non-clinical case management for both medical and dental services, and medical support assistance. Responses are due by April 4th, 2022 to be considered for a firm-fixed-price contract with one base year and four option years. The services are required at the National Guard location in Latham, New York to ensure individual medical readiness goals are achieved for New York Army National Guard soldiers. Interested service-disabled veteran-owned small businesses meeting the identified NAICS code and registered in SAM should complete and submit the attached response form along with two similar past performance references by the response deadline.
View the file
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Sources Sought Information Request Form
Project Number/Title: Medical and Dental Support Services New York National Guard No Bonding requirement NAICS Code: 541611
Interested firms please respond with this information form and the following requested information. Please complete all sections of the document.
1. Company Information:
2.
Company name:______________________________________________
Company Address as registered in SAM:
( ) I have confirmed that my address listed above is exactly the same as listed in SAM
( ) The above address is not the same in SAM, but registration is being corrected to the above listed address
DUNS Number: ________________________________
CAGE Code______________________________
UEI________________________________________
Socio-economic status for the listed NAICS code - please check all that apply:
( ) Small business ( ) Small disadvantaged business ( ) 8(a) program participant ( ) HUB Zone business ( ) Woman-Owned business ( ) Service-Disabled Veteran-Owned Small Business ( ) Economically Disadvantage Woman Owned Small Business.
The firm must be registered in SAM (https://sam.gov/) with the socio-economic status identified above and the NAICS code specified in the sources sought notice.
( ) I have confirmed that my firm is registered in SAM for the NAICS code and business type selected
( ) My firm is not registered in SAM with the NAICS code and business status selected, but the firm qualifies and registration is in process
( ) My firm is not registered in SAM for the identified NAICS code
2. Examples of similar work:
( ) I have attached two references for similar work that our firm has performed.
( ) I have not attached two references of similar work that our firm has performed.
Certification:
I understand that incomplete answers in sections or my failure to provide required documentation or failure to sign this certification may remove my firm from consideration for this project sources sought notice.
Signature: _____________________________________________
Name: ________________________________________________
Title: ________________________________________________
Phone Number: ________________________________________
E-mail________________________________________________
File details come from the government source that posted it. Updated .