Market_Survey_57928560.doc

DEFENSE LOGISTICS AGENCY

DEFENSE SUPPLY CENTER, COLUMBUS

POST OFFICE BOX 3990

COLUMBUS, OH 43218-3990

Information provided below is for Government’s internal use only.

This is “NOT” a Request for Proposal.

DATE:

COMPANY:

ATTN:

ADDRESS:

PHONE:

E-MAIL:

FROM: Mandy Phipps-Kuhlman

PHONE: 614-692-8675

FAX: 614-693-1614

E-MAIL: mandy.phipps-kuhlman@dla.mil Item listed below is being considered for solicitation and subsequent award.

Please respond by 1:00 PM June 23, 2015 to Mandy Phipps-Kuhlman at the above FAX/E-mail address.

E-mail is preferred.

SOLICITATION ITEM REQUIREMENTS:

NSN: 4730-01-572-1223

PART NUMBER: CAGE 52661, p/n 4050905; CAGE 86831, p/n 0003-0018

PREVIOUS CONTRACT: N0038312G001MU385

NOMENCLATURE: adapter, straight, tube to boss

ESTIMATED QUANTITY: 1,113 EA

REQUESTED DELIVERY: 170

SPECIAL CONSIDERATIONS: Air Force Critical Safety Item

SURVEY COMPLETED BY: _______________________________________

(name and title)

PHONE:_________________________ FAX:_________________________ E-MAIL:_____________________________

DATE:___________________________

SURVEY QUESTIONNAIRE

1. Your company size?

Large Business [ ]

Small Business [ ]

Other* [ ] ________________________________________

*if Small Business or other qualifying as a Small Business list number of employees: ________

2. Your company is a:

Manufacturer [ ]

Dealer/Distributor [ ]

3. Is your company registered in the System for Award Management (SAM)?

Yes [ ]; No [ ]

If no, are you willing to obtain this registration? Yes [ ]; No [ ]

4. Is your company ORCA certified?

Yes [ ]; No [ ]

If your ORCA certification up to date? Yes [ ]; No [ ]

*Please be advised, in order to qualify for Federal Government contracts over $150,000 you must be SAM/ ORCA certified with current registration.

5. Is this a commercial item?

Yes [ ]; No [ ]

If yes, please answer questions 6 through 8.

6. Item is commercial and our company sold ________% to private sector and ________% to government.

7. Will you comply with the solicitation clauses and requirements for commercial items I/A/W FAR Part 12 or FAR Part 13.5 – Acquisition of Commercial Items?

Yes [ ]; No [ ]

8. Is this a price listed item?

Yes [ ]; No [ ]

If yes please provide the link to your price list.

9. This item is NOT commercial because: (please specify the weapon system used: aircraft, tactical vehicles, etc)

10. If item is NOT commercial will you comply with the solicitation clauses/requirements I/A/W FAR part 15 – Contracting Negotiation (non-commercial)?

Yes [ ]; No [ ]

11. Is this a catalog/ price listed item?

Yes [ ]; No [ ]

12. Is this item on a GSA schedule?

Yes [ ]; No [ ]

If yes please supply a copy of the schedule.

13. Do you carry this item in your inventory?

Yes [ ]; No [ ]

If yes, what is your current capacity? __________________ UM: _________

14. Would you be willing to submit an offer on this item?

Yes [ ]; No [ ]

If no, please explain___________________________________________________________________________

15. What would be the most appropriate incremental quantity breaks for this item?

From: ___________To___________; From___________ To___________; From: ___________ To___________ UM: _______

From: ___________To___________; From___________ To___________; From: ___________ To ___________ UM: _______

16. What would be the estimated production of this item per month? ___________

17. What would be the approximate delivery time for this item?

For all quantity breaks [ ]: __________ days

For phased delivery [ ]:

Up to _____________ at ____________ days

Up to _____________ at ____________ days

18. Is FOB origin acceptable?

Yes[ ]; No [ ]

19. Is inspection/ acceptance at origin acceptable?

Yes[ ]; No [ ]

20. Do you have electronic data interchange (EDI) capability?

Yes [ ]; No [ ]

If no, are you willing to obtain this capability? Yes [ ]; No [ ]

Any additional comments/ information not included above?

Thank you for your time.

Mandy Phipps-Kuhlman

Contract Specialist

DLA Land and Maritime – FMDD

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