TEMPLATE - A.02 Sources Sought Response Form (24-R-XXXX).docx
DOCX document 22 KB Posted
- Attached to
- G1 - Non Clinical Case Management Services
- Solicitation number
- W912L325R1001
About this file
This is a Sources Sought Response Form template that contractors must complete to respond to a sources sought notice for Non-Clinical Case Management Services for the Wyoming Army National Guard. The template requires companies to provide basic information including company name, SAM registration address, CAGE code, DUNS number, and socioeconomic status designations (Large Business, Small Business, Small Disadvantaged Business, 8(a), HUBZone, Woman-Owned, or Service-Disabled Veteran-Owned Small Business).
The form requires respondents to certify they are registered in SAM.gov under the specified NAICS code or have registration in process. The related opportunity seeks contractors to provide Non-Clinical Case Management Services to prepare, track and assess medical readiness of Wyoming Army National Guard service members, including coordinating care plans from injury/illness through return to duty or medical separation.
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Other files
| File | Type | Posted |
|---|---|---|
| A.02 Sources Sought Notice (25R1001).pdf |
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Text version
NAICS Code:
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 System for Award Management (SAM):
CAGE Code:
DUNS 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)
By responding to the Sources Sought Notice, I confirm that my firm is registered in the System for Award Management (SAM) https://www.sam.gov/ with the socio‐economic status identified above and the NAICS code specified in the sources sought notice; or that my firm qualifies and registration under the applicable NAICS code is in process.
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 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.
Name: _______________________________
Title: _______________________________
Signature: _______________________________
File details come from the government source that posted it. Updated .