SPE8EZ18Q0099.PDF

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Attached to: CONNECTOR, ORIFICE A Federal contract opportunity
Solicitation number: SPE8EZ18Q0099
Issued by: Defense Logistics Agency Troop Support Medical

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REQUEST FOR QUOTATIONS THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDE

4. CERT.FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG. 1

5. ISSUED BY

7. DELIVERY

9. DESTINATION

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5 ON OR

BEFORE CLOSE OF BUSINESS (Date)

IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (See Continuation Sheets)

12. DISCOUNT FOR PROMPT PAYMENT

d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

14. SIGNATURE OF PERSON AUTHORIZED TO SIGN

QUOTATION

16. SIGNER

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not useable

STANDARD FORM 18 (REV. 6-95)

Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

1. REQUEST NO.

SPE8EZ-18-Q-0099

2. DATE ISSUED

2018 MAR 08

3. REQUISITION/PURCHASE REQUEST NO.

0073289951

RATING

DO-A4

DLA TROOP SUPPORT

CONSTRUCTION & EQUIPMENT (OP M L&R)

700 ROBBINS AVENUE PHILA PA 19111

PHILADELPHIA PA 19111

USA

Buyer: Richard Balezzi PEPCSFC Tel: 215-737-4154 Email: richard.ballezzi@dla.mil

6. DELIVER BY (Date)

SEE SCHEDULE

8. TO:

c. CITY

d. STATE

b. STREET ADDRESS

a. NAME OF CONSIGNEE

e. ZIP CODE

a. 10 CALENDAR DAYS

b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS

15. DATE OF QUOTATION

a. NAME (Type or Print)

AREA CODE

c. TITLE (Type or Print)d. CITY

c. COUNTY

b. STREET ADDRESS

e. STATE f. ZIP CODE

See Schedule

2018 MAR 09

NUMBER

FOB DESTINATION

OTHER

(See Schedule)

CAGE

b. TELEPHONE

See attached schedule to complete quote information.

Quoter must also complete the following:

a. Quotation is valid for 90 days from date specified in Block 10 above unless otherwise indicated: _____________ .

b. Prices quoted are:

___ Contained in Commercial Catalog or Published Price List No. ___________________ dated _______________ page __________ .

___ Contained in Internal Price List No. _______________dated ____________________, which may be examined at our facility.

___ Commercial sales of comparable quantities: Quantity ____________ ; Price _____________;

___ Customer ________________________.

___ Other (provide basis) ______________________________________ _______________________________________ .

c. FOB Point: ____ Destination ____ Origin Shipping Point (City, State) _________________________________________ .

d. If delivery period shown in Block 6 is unacceptable, provide best possible delivery: _________________________________.

e. Remittance Address (Name, Street, City, State, ZIP): Same as Block 13 unless otherwise indicated below:

f. Vendor FAX Number: ____________________ Vendor Toll-Free Number: ____________________ Vendor E-mail: ______________________________

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 2 OF 9 PAGES

SPE8EZ-18-Q-0099

CONTINUED ON NEXT PAGE

SOLICITATION POC INFORMATION:

QUESTIONS REGARDING THE DLA-BSM INTERNET BID BOARD SYSTEM SHOULD BE E-MAILED to DibbsBSM@dla.mil FOR IMMEDIATE ASSISTANCE, PLEASE REFER TO THE FREQUENTLY ASKED QUESTIONS (FAQS) ON BSM DIBBS AT: _https://www.dibbs.bsm.dla.mil/ Refs/help/DIBBSHelp.htm OR PHONE 1-877-DLA-CALL (1-877-352-2255).

DISCREPANCIES FOUND IN BIDSETS SHOULD BE E-MAILED TO Dscr.PdmdDistribution@dla.mil ALL OTHER QUESTIONS (SOLICITATION REQUIREMENTS, ITEM DESCRIPTION, AWARD CHOICE, ETC.), PLEASE CONTACT THE BUYER AT Richard.Ballezzi@dla.mil

MASTER SOLICITATION

THIS SOLICITATION INCORPORATES THE TERMS AND CONDITIONS SET FORTH IN THE DLA MASTER SOLICITATION FOR EPROCUREMENT AUTOMATED SIMPLIFIED ACQUISITIONS (PART 13) WHICH CAN BE FOUND ON THE WEB AT: http://www.dla.mil/HQ/Acquisition/ Offers/eProcurement.aspx

52.219-06 – Notice of Total Small Business Set-Aside 52.247-29 – F.O.B. Origin 52.246-02– Inspection of Supplies – Fixed-Price 52.246-9008– Inspection and Acceptance at Origin 52.246-9004– Product Verification Testing 52.246-9054– Warranty – Acceptance of Supplies 52.246-9003– Measuring and Test Equipment 52.246-9062 – Repackaging to Correct Packaging Deficiencies 52.246-9086– Production Lot Testing (contractor) 52.209-03– First Article Approval – Contractor Testing (contractor) 52.209-03 – First Article Approval – Contractor Testing, ALT I (contractor) 52.209-9017– First Article Contractor Testing – Additional Requirements (contractor)

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 3 OF 9 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLIES/SERVICES: 4240-00-007-9453

ITEM DESCRIPTION:

CONNECTOR, ORIFICE ASSY.

RP001: DLA PACKAGING REQUIREMENTS FOR PROCUREMENT

RQ006: QUALITY CONFORMANCE INSPECTION REQUIREMENTS

RA001: THIS DOCUMENT INCORPORATES TECHNICAL AND/OR QUALITY REQUIREMENTS

(IDENTIFIED BY AN 'R' OR AN 'I' NUMBER) SET FORTH IN FULL TEXT IN THE

DLA MASTER LIST OF TECHNICAL AND QUALITY REQUIREMENTS FOUND ON THE WEB

AT: http://www.dla.mil/HQ/Acquisition/Offers/eProcurement.aspx. FOR

SIMPLIFIED ACQUISITIONS, THE REVISION OF THE MASTER IN EFFECT ON THE

SOLICITATION ISSUE DATE OR THE AWARD DATE CONTROLS. FOR LARGE

ACQUISITIONS, THE REVISION OF THE MASTER IN EFFECT ON THE RFP ISSUE DATE

APPLIES UNLESS A SOLICITATION AMENDMENT INCORPORATES A FOLLOW-ON

REVISION, IN WHICH CASE THE AMENDMENT DATE CONTROLS.

RQ009: INSPECTION AND ACCEPTANCE AT ORIGIN

RQ011: REMOVAL OF GOVERNMENT IDENTIFICATION FROM NON-ACCEPTED SUPPLIES

FAR CLAUSE 52.246-11 APPLIES. THE CONTRACTOR SHALL BE IN COMPLIANCE

WITH THE FULL REQUIREMENTS OF THE INTERNATIONAL ORGANIZATION FOR

STANDARDIZATION (ISO) 9001 STANDARD AT THE TIME OF CONTRACT ACCEPTANCE

OR CONTRACT MODIFICATION DATE.

1. The minimum Higher Level Contract Quality Requirements for manufacturers for DLA is ISO 9001:2008 or ISO 9001:2015. MIL-I-45208 and MIL-Q-9858 are obsolete and no longer acceptable when higher level quality is required.

2. Higher-Level Contract Quality Requirement for Non-Manufacturers. If a non-manufacturer is supplying the material, the non-manufacturer shall:

(i) Furnish items produced at a manufacturing facility conforming to the higher-level contract quality requirement for manufacturers as specified in paragraph 1; and

(ii) Maintain and provide documented evidence that material furnished under this contract was produced at a manufacturing facility conforming to the specified higher-level contract quality requirement and that the material meets all requirements. At a minimum, the documented evidence shall be sufficient to establish the identity of the product and its manufacturing source; and include the basic item description, the item(s) part number and/or national stock number, the item(s) manufacturing source , the manufacturing source#s commercial and government entity code (e.g. CAGE code), and clear identification of the name and location of supply chain intermediaries from the manufacturer to the direct source of the product for the offeror/contractor, to the item(s) acceptance by the Government. It should also include, where available, the manufacturer's batch identification for the part(s), such as date codes, lot codes, or serial numbers.

(iii) Maintain documentation of the Non-Manufacturers# quality assurance program; receiving/verification processes; records management system;

procurement system; inventory control system; testing results; and any other records associated with the material being provided.

(End of TQ Requirement)

SAMPLING:

THE SAMPLING METHOD SHALL BE IN ACCORDANCE WITH MIL-STD-1916 OR ASQ

H1331, TABLE 1 OR A COMPARABLE ZERO BASED SAMPLING PLAN UNLESS OTHERWISE

SPECIFIED BY THE CONTRACT. IF THE APPLICABLE DRAWING, SPECIFICATION,

STANDARD, OR QUALITY ASSURANCE PROVISION (QAP) SPECIFIES CRITICAL, MAJOR

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 4 OF 9 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 4240-00-007-9453 CONT'D

AND/OR MINOR ATTRIBUTES, THEY SHALL BE ASSIGNED VERIFICAITON LEVELS OF

VII, IV AND II OR AQLS OF 0.1, 1.0 AND 4.0 RESPECTIVELY. UNSPECIFIED

ATTRIBUTES SHALL BE CONSIDERED AS MAJOR UNLESS SAMPLING PLANS ARE

SPECIFIED IN APPLICABLE DOCUMENTS. FOR MIL-STD-1916, THE MANUFACTURER

MAY USE THE ATTRIBUTE OR VARIABLE INSPECTION METHOD AT THEIR OPTION OR

PER THE CONTRACT. MIL-STD-105/ASQ Z1.4 MAY BE USED TO SET SAMPLE LOT

SIZE, BUT ACCEPTANCE WOULD BE ZERO NON-CONFORMANCES IN THE SAMPLE LOT

UNLESS OTHERWISE SPECIFIED IN THE CONTRACT.

Higher Level Contract QA Requirement Quality Management System - ISO 9001:2008 Requirements

- Tailored by excluding paragraph 7.3

FIRST ARTICLE TEST REQUIRED:

The contractor shall conduct a First Article Test (FAT) on three (3) orifice assemblies, PN: 5-19-1829, and all subcomponents shall be inspected/tested to all requirements of the drawing, specification and QAP requirement. For the outlet valve disk, PN 5-1-3525, (50) fifty shall be inspected/tested to all requirements of the Para 4, DTL-EA-R-1378C w/amendment 3 to include Para 4.1. Toxicity certification and or testing plus para 4.2, FAT inspection .

A First Article Test Report (FATR)shall be completed by the contractor documenting the results of all inspections and test (including suppliers and vendors inspection records and certifications, when applicable). The FATR shall include actual inspection and test results to include measurements, recorded test data, and certifications (if applicable) keyed to each drawing, specification and QAP requirement, identified by each individual QAP characteristic and drawing/specification characteristic.

Certificates of Conformances (see CDRL for COC format IAW DI-MISC-81356A) are require for all material and shall be submitted as part of the FATR. The contractor is responsible for all inspections and testing regardless of who conducts the actual testing.

A packaging FAT is required and shall consist of three (3) packaged units and inspected IAW SPI P5-19-1829.

For the outlet valve disk, PN 5-1-3525, the Toxicity certification and or testing, Para 4.1 of DTL-EA-R-1378C w/amendment 3 could be waived if the manufacturer can provide previous test data which meets the requirements of para 4.1 and certifies that the item being supplied for this procurement uses the same rubber formulation.

DESTRUCTIVE TESTING (Allow for extra FAT material)

CONTRACTOR PRODUCTION LOT TEST REQUIRED:

1A. Test Requirements: IAW the various QAPs for pn's 5-19-1830, 5-19-160, and the applicable specifications for pn's 5-19-159 and 5-1-3525 as well as SPI P5-19-1829.

2A. Production/Conformance report submitted within 10 working days to

DCMA*

3A. Approval/Disapproval: 10 Days unless other time frame agreed to by all parties.

The following Engineering Exceptions shall apply:

For all drawings and Specifications, Distribution Statement C shall be enforced stated as follows, SPI's shall remain Distribution Statement A:

DISTRIBUTION STATEMENT C. Distribution authorized to U.S. Government agencies and their contractors, Critical Technology, Date of Determination, 2013-03-19. Other requests for this document shall be referred to Technical Director, Edgewood Chemical Biological Center, ATTN: RDCB-DEA-D, APG, MD 21010-5424.

1) It is recommended that the item per drawing 5-1-3525, NSN 4240-01-502-7372, to be ordered from the government supply system.

2) Make the following specification changes:

QQ-A-225/8 to ASTM B211 ANSI B46.1 to ASME B46.1

3) Package per P5-19-1829.

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 5 OF 9 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 4240-00-007-9453 CONT'D

4) In TDPL, NOR 349-0178-002 is no longer needed and should be removed.

THE DRAWING(S) LISTED BELOW ARE AVAILABLE AT

DLA DURING *OPEN SOLICITATION ONLY*.

TO RECEIVE A COPY OF THE DRAWING(S),

FOR EBS SOLICITATIONS USE URL

HTTPS://WWW.DIBBS.BSM.DLA.MIL/RFQ/

CRITICAL ITEM - SOURCE INSPECTION REQUIRED.

PURCHASE DESCRIPTION

CRITICAL APPLICATION ITEM

IAW BASIC DRAWING NR 81361 5-19-1829

REVISION NR F DTD 10/29/2014

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5220-A50-9820

REVISION NR E DTD 05/19/1995

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-19-1829

REVISION NR F DTD 11/07/2014

PART PIECE NUMBER:

IAW REFERENCE QAP 81361 5-9-160

REVISION NR A DTD 06/12/2013

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-9-161

REVISION NR K DTD 10/29/2014

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-19-1830

REVISION NR F DTD 10/29/2014

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-9-159

REVISION NR M DTD 10/29/2014

PART PIECE NUMBER:

IAW REFERENCE QAP 81361 5-19-1830

REVISION NR DTD 08/27/1987

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-9-160

REVISION NR L DTD 10/29/2014

PART PIECE NUMBER:

IAW REFERENCE SPEC NR MIL-DTL-51195C

REVISION NR DTD 06/20/2016

PART PIECE NUMBER:

IAW REFERENCE UNK DI-NDTI-80809B NOT 1

REVISION NR B DTD 08/27/2014

PART PIECE NUMBER:

IAW REFERENCE UNK DI-MISC-81356A

REVISION NR A DTD 12/18/2007

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-1-3525

REVISION NR C DTD 10/29/2014

PART PIECE NUMBER:

IAW REFERENCE NON GOVT STD ISO9001:2008

REVISION NR DTD 12/01/2008

PART PIECE NUMBER:

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 6 OF 9 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 4240-00-007-9453 CONT'D

IAW REFERENCE DRAWING NR 81361 P5-19-1829

REVISION NR DTD 11/05/2014

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 EA-R-1378C

REVISION NR 3 DTD 02/19/2014

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 136-44-1-9

REVISION NR D DTD 10/29/2014

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-19-1830

REVISION NR DTD 11/07/2014

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-9-160

REVISION NR A DTD 11/07/2014

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 81361 5-19-1829

REVISION NR DTD 11/12/2014

PART PIECE NUMBER:

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT .

0001 4240-00-007-9453 13,000.000 EA $ ________________ $ ________________

CONNECTOR,ORIFICE

PRICING TERMS: Firm Fixed Price

QTY VARIANCE: PLUS 0% MINUS 0%

INSPECTION POINT: ORIGIN

ACCEPTANCE POINT: ORIGIN

FOB: ORIGIN DELIVERY DATE: 90 DAYS ADO

PREP FOR DELIVERY:

PKGING DATA - MIL-STD-2073-1D, 15 DEC 1999

QUP:001 PRES MTHD:31 CLNG/DRY:1 PRESV MAT:00

WRAP MAT:ZZ CUSH/DUNN MAT:00 CUSH/DUNN THKNESS:0

UNIT CONT:ZZ OPI:M

INTRMDTE CONT:D3 INTRMDTE CONT QTY:AAA

PACK CODE:U

MARKING SHALL BE IN ACCORDANCE WITH MIL-STD-129.

SPECIAL MARKING CODE:00 -00 No special marking

PALLETIZATION SHALL BE IN ACCORDANCE WITH MD00100452 REV B DATED JULY 01, 2008

ALL Z's IN PACKAGING REFER TO SPI P5-19-1829

WHENEVER POSSIBLE AND WHEN PERMITTED BY THE

TERMS OF THE CONTRACT, AVOID THE USE OF

PLASTICS AS WRAPPING, CUSHIONING, OR

DUNNAGE MATERIALS.

IP025: PACKAGING, MARKING, AND SHIPPING OF HAZARDOUS MATERIALS

PARCEL POST ADDRESS:

SW3215

DLA DISTRIBUTION BARSTOW

CENTRAL RECEIVING WHSE 7

REC OFFICER 760 577 6442

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 7 OF 9 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 4240-00-007-9453 CONT'D

BARSTOW CA 92311-5014

FOR TRANSPORTATION ASSISTANCE SEE DLAD 52.247-9034. FOR FIRST DESTINATION TRANSPORTATION (FDT) AWARDS SEE DLAD

52.247-9059 AND

CONTRACT INSTRUCTIONS INSTEAD.

FREIGHT SHIPPING ADDRESS:

SW3215

DLA DISTRIBUTION BARSTOW

CENTRAL RECEIVING WHSE 7

REC OFFICER 760 577 6442

BARSTOW CA 92311-5014

Contractor First Article Test Contractor First Article Test – The number of units shown signifies the test requirement. See FAR clause 52.209-3 for the actual quantity required to be tested.

0002 0001 - S00000053 1.000 EA $ ________________ $ ________________

FOB: DELIVERY DATE: 60 DAYS ADO

PREP FOR DELIVERY:

Not Applicable

Production Lot Testing (Contractor)

0003 0001 - S00000062 1.000 EA $ ________________ $ ________________

INSPECTION POINT: ORIGIN

ACCEPTANCE POINT: ORIGIN

FOB: ORIGIN DELIVERY DATE: 45 DAYS ADO

PREP FOR DELIVERY:

Not Applicable

GOVT USE

External External External Customer RDD/ ITEM PR PRLI PR PRLI Material Need Ship Date .

0001 0073289951 0001 N/A N/A N/A 04/07/2018

0002 N/A N/A N/A N/A N/A N/A

0003 N/A N/A N/A N/A N/A N/A

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 8 OF 9 PAGES

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SECTION I - CONTRACT CLAUSES

52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS (OCT 2016) FAR

52.204-15 SERVICE CONTRACT REPORTING REQUIREMENTS FOR INDEFINITE-DELIVERY CONTRACTS (OCT 2016) FAR

52.204-16 COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTING (JUL 2016) FAR

52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE (JUL 2016) FAR

52.204-20 PREDECESSOR OF OFFEROR (JUL 2016) FAR

As prescribed in 4.1804(d), insert the following provision:

(a) Definitions. As used in this provision - “Commercial and Government Entity (CAGE) code” means -

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

“Predecessor” means an entity that is replaced by a successor and includes any predecessors of the predecessor.

“Successor” means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

(b) The Offeror represents that it [ ] is or [ ] is not a successor to a predecessor that held a Federal contract or grant within the last three years.

(c) If the Offeror has indicated “is” in paragraph (b) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order):

Predecessor CAGE code: (or mark “Unknown”) Predecessor legal name:

(Do not use a “doing business as” name)

(End of provision)

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND STATEMENTS

52.204-17 OWNERSHIP OR CONTROL OF OFFEROR (JUL 2016) FAR

As prescribed in 4.1804(b), use the following provision:

(a) Definitions. As used in this provision -

“Commercial and Government Entity (CAGE) code” means -

“Highest-level owner” means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

“Immediate owner” means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 9 OF 9 PAGES

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND STATEMENTS (CONTINUED)

(b) The Offeror represents that it [ ] has or [ ] does not have an immediate owner. If the Offeror has more than one immediate owner (such as a joint venture), then the Offeror shall respond to paragraph (c) and if applicable, paragraph (d) of this provision for each participant in the joint venture.

Immediate owner CAGE code:

Immediate owner legal name:

(Do not use a “doing business as” name)

Is the immediate owner owned or controlled by another entity?: [ ] Yes or [ ] No.

(d) If the Offeror indicates “yes” in paragraph (c) of this provision, indicating that the immediate owner is owned or controlled by another entity, then enter the following information:

Highest-level owner CAGE code:

Highest-level owner legal name:

(Do not use a “doing business as” name)

(End of provision)

CONTINUATION SHEET