Market_Survey_Blank.doc

MARKET SURVEY

mARCh 12, 2015

RETURN FAX TO 614-692-8565

PHONE NUMBER 614-693-1612

amy.plymale-hillis@dla.mil

I am preparing to issue a Request For Proposal (RFP) for the following part. Your answers to the following questions will help me develop the solicitation. Please respond to this Market Survey by close of March 23, 2015.

COMPANY NAME:

CAGE:

ADDRESS:

CITY:

STATE:

ZIP CODE:

ATTN:

PHONE:

FAX:

DESCRIPTION

PR: 0056814588

NSN: 5998-01-417-9737

Item: Circuit Card Assembly (CAGE 058R3 P/N 711860-1)

Quantity: 12 (Price breaks included up to quantity 18) Delivery: Please Provide Delivery Location: Warner Robins, GA Ship to address: 455 Byron Street Bldg 376 Robins AFB GA 31098-1887 F.O.B Requested: Origin I/A Requested: Destination

PLEASE SELECT:

Manufacturer Approved QPL Source

Qualified Supplier List of Distributors (QSLD)

Qualified Testing Supplier List (QTSL)

Authorized Distributor: Source of Supply: CAGE:

Dealer: Source of Supply: CAGE:

Business Size:

Large

Small

Do you deal through Dealers/Distributors or do you prefer dealing directly with the Government?

Are these commercial items? Yes / No

Are these catalog/price listed items? Yes / No

Are these items in your inventory? Yes / No

Are you willing to quote on these items? Yes / No If not, please state why:

What would you consider economical production quantities? Yes / No What is the approximate delivery for this quantity?

What would be the most appropriate incremental quantity breaks?

Would you be willing to accept a priced quantity option? Yes / No Is your company registered with the System for Award Management (SAM)? Yes / No