Sources_Sought_Information_Request_Form.pdf

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Non-Clinical Dental and Medical Case Management
Solicitation number
W91243-18-R-E001
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Sources Sought Form

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W91243-18-R-E001_PWS_FBO.pdf PDF

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Sources Sought Information Request Form

NAICS Code Company Name Company Information Company Address as registered in System for Award Management (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 CAGE Code

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 System for Award Management (SAM).

https://www.sam.gov/portal/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.

https://www.sam.gov/portal/SAM/

Capabilities Statement

This contract is for services in Lincoln, Nebraska, the services cannot be completed remotely. How can your company provide the required services?

Has your company had on a similar contract in the last three years? If so, please provide details to include the contract number.

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.

Printed Name Title Phone Number Signature

Are there specific requirements in the documentation that has the effect of limiting competition among potential vendors?

Is there an alternate NAICS that you believe is more appropriate for this requirement? Is so, what is the NAICS and why?

Is there anything in the PWS that has the effect of creating duplicative or unnecssary costs to the Government? Do you have any additional comments on the PWS?

Blank Page

NAICS Code:
Company Name:
Company Information:
Company Address as registered in System for Award Management SAM:
DUNS Number:
CAGE Code:
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Printed Name:
Title:
Phone Number:
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