Sources Sought Response Form - 12505B24Q0043SS.pdf
PDF 167 KB Posted
- Attached to
- Jaw Crusher
- Solicitation number
- 12505B25Q0043SS
About this file
This is a Sources Sought Response Form template issued by the USDA Agricultural Research Service (ARS) Midwest Area Administrative Office for solicitation number 12505B24Q0043SS regarding a Benchtop Jawcrusher requirement.
The form requires vendors to provide their company information, including SAM registration status, UEI number, legal name, CAGE codes, and socio-economic status under NAICS code 334516 (Analytical Laboratory Instrument Manufacturing) which has a small business threshold of 1,000 employees. The form includes checkboxes for various business categories including Small Business, 8(a), HUBZone, Veteran-Owned, Woman-Owned, and others. It requires certification that the company is properly registered in SAM with the claimed socio-economic status, and includes signature fields for company officials to certify the information provided. This form is part of market research to determine potential set-aside decisions for the procurement of a Benchtop Jawcrusher.
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Other files
| File | Type | Posted |
|---|---|---|
| Crusher Specifications document.pdf |
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Text version
United States Department of Agriculture
Office of the Director ● Midwest Area Administrative Office Acquisitions & Personal Property/Fleet Team
1815 North University Street ● Peoria, IL 61604 USDA is an Equal Opportunity Provider and Employer
Research, Education, and Economics Agricultural Research Service
SOURCES SOUGHT RESPONSE FORM
N o
Interested vendors please respond with the following information form. Please be certain to complete all sections of the document.
Sources South Title: Benchtop Jawcrusher.
Sources Sought Number: 12505B24Q0043SS
Company Information:
Currently Registered and Active in the System for Award Management (SAM): Yes
SAM Unique Entity Identifier (UEI) Number:
Company Legal Name:
Doing Business As (if applicable):
Company Address as registered in the System for Award Management (SAM):
( ) Small Business Concern Disadvantaged
SBA-certified HUB Zone Business
Service-Disabled Veteran Owned
Economically Disadvantaged Woman Owned
SBA-certified 8(a) Program Participant
Veteran Owned
Woman-Owned ( ) Large Business
Socio-economic status for the NAICS code: 334516 (with a small business threshold of 1,000 employees) -- please check all that apply:
CAGE CODES:
United States Department of Agriculture
Office of the Director ● Midwest Area Administrative Office Acquisitions & Personal Property/Fleet Team
1815 North University Street ● Peoria, IL 61604 USDA is an Equal Opportunity Provider and Employer
Research, Education, and Economics Agricultural Research Service
I confirm that my company is registered in the System for Award Management (SAM) with the socio-economic status identified above for the NAICS code specified or that my company qualifies for the selected socio-economic status under the specified NAICS code and registration under the applicable NAICS code is in progress.
Certification:
I understand that incomplete sections, failure to provide all required documentation, and/or failure to sign this certification may remove my company from the Government’s determination of whether to solicit the referenced project on a set-aside basis in accordance with Part 19 of the Federal Acquisition Regulation.
Signature:
Name:
Title:
Date:
| Company Information: |
| Certification: |
| SAM Unique Entity Identifier UEI Number: |
| Company Legal Name: |
| Doing Business As if applicable: |
| Company Address as registered in the System for Award Management SAM 1: |
| Company Address as registered in the System for Award Management SAM 2: |
| Company Address as registered in the System for Award Management SAM 3: |
| Company Address as registered in the System for Award Management SAM 4: |
| CAGE Codes: |
| Name: |
| Title: |
| Date: |
| Group1: Off |
File details come from the government source that posted it. Updated .