Sources_Sought_Information_Form Mobile Dental.docx
DOCX document 22 KB Posted
- Attached to
- NYANRG Mobile Dental Services Sources Sought
- Solicitation number
- 0012202403
About this file
This document is a Sources Sought Information Request Form related to a federal contract opportunity for Mobile Dental Services. The New York Army National Guard (NYARNG) is seeking industry information to identify potential sources to provide mobile dental services. Interested firms must complete the form and provide information such as company details, socio-economic status, examples of similar work, and confirmation of SAM registration. The government is conducting market research to determine the appropriate procurement method if a requirement materializes. No evaluations or feedback will be provided to responding companies. The required services include providing all management, personnel, equipment, tools, materials, supervision, certifications, and supplies necessary to perform mobile dental services in compliance with relevant regulations. The goal is to achieve dental readiness for National Guard members, with results entered into the DENCLASS database. Responses to the sources sought must be submitted via email to the Contract Specialist.
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Text version
Sources Sought Information Request Form - Page 1 of 2 Project Name: Mobile Dental Services Base and 4 Option Years
NAICS Code: _621210
Interested firms please respond with this information form and the following requested information. Please complete all sections of the document.
1. Company Information:
Company name: Company Address as registered in SAM at sam.gov :
( ) 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
UEI Number:
Socio-economic status for the listed NAICS code - please 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) |
The firm must be registered in SAM (sam.gov ) with the socio-economic status identified above and the NAICS code specified in the sources sought notice. If the firm’s SAM record does not include this project’s NAICS code, the firm will not be considered.
( ) 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
Sources Sought Information Request Form - Page 2 of 2
2. Examples of similar work:
( ) I have attached three references for similar work that our firm has performed.
( ) I have not attached three 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:
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