Sources_Sought_Information_Request_Form.pdf

Sources Sought Information Request Form

NAICS Code: 236210

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) (formally CCR):

Address Line 1:

Address Line 2:

Address Line 3:

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

HUB Zone business

8(a) program participant

Service‐Disabled Veteran‐Owned Small Business (SDVOSB)

The firm must be registered in System for Award Management (SAM) https://www.sam.gov/portal/public/SAM/ 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

Woman-Owned small business

2. Bonding Capability

Individual Project Bonding:

Total Aggregate Bonding:

Company point of contact information:

Name:

Title:

Phone Number:

Email:

Signature (Ink or Digital):