08_Offering_Entity_Acknowledgement_Form_(Detroit).docx

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Department of Veteran Affairs Detroit Domiciliary 32, 248 ABOA ANSI/BOMA Square Feet Detroit, MI
Solicitation number
VA10116R0143
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Attachment G

VA DOMICILIARY

DETROIT, MICH.

RLP No. VA-101-16-R-0143

Offering Entity Acknowledgement for RLP No. VA-101-16-R-0143

The Offeror attests that the information provided below is accurate and shall be a basis for evaluation in RLP No. VA-101-16-R-0143. Failure to provide the required information may deem your proposal non-responsive.

Offeror Information

Offering Entity Name:

Address:

Offering Entity DUNS Number:

Offering Entity Tax Identification Number:

Authorized Official Name:

Authorized Official Phone Number:

Authorized Official E-mail:

Authorized Official is Listed in Entity SAM Representation:|_| Yes |_| No
Authorized Official is Listed in Entity Operating Agreement:|_| Yes |_| No

Date of Submission:

Time Specified for Receipt of Offers:

Offering Entity/Prime Contractor Size Status:SDVOSB|_|
VOSB|_|
SB|_|

Offering Entity Currently Certified in SAM under NAICS 531120: |_|

Offering Entity Currently Verified in VetBiz: |_|

____________________________________
Offering Entity POC SignatureDate

Offering Entity POC Name

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