Sources_Sought_Information_Request_Form.docx

Sources Sought Information Request Form - Page 1 of 2 Project Name: DBEH143000 Space Control Facility, Cape Canaveral AFS Bonding requirement: Bid, Performance and Payment NAICS Code: 236220 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 SAM:

( ) I have confirmed that my address listed above is exactly the same as listed in SAM ( ) The above address is not the same in SAM, but registration is being corrected to the above listed address 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) The firm must be registered in SAM (www.sam.gov) with the socio-economic status identified above and the NAICS code specified in the sources sought notice. If the firm’s SAM record does not include this project’s NAICS code, the firm will not be considered.

( ) I have confirmed that my firm is registered in SAM for the NAICS code and business type selected ( ) My firm is not registered in SAM with the NAICS code and business status selected, but the firm qualifies and registration is in process ( ) My firm is not registered in SAM for the identified NAICS code

2. Bonding Capability:

Individual Project Bonding: _____________________ Total Aggregate Bonding Capability: _____________________ This response must include a letter from your bonding company confirming this amount to be considered.

( ) Bonding letter and/or certificate from bonding provider for amount listed above is attached with my response ( ) My firm does not have a bonding capacity letter ( ) My firm cannot bond to the stated bond requirement

3. Examples of similar work:

( ) I have attached three references for similar work that our firm has performed.

Sources Sought Information Request Form - Page 2 of 2 ( ) I have not attached three references of similar work that our firm has performed.

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 consideration for this project sources sought notice.

Signature:_____________________________________________ Name: ________________________________________________ Title: ________________________________________________ Phone Number: _______________________