Sources Sought Info Request Form_Final.pdf

Sources Sought Info Request Form

Subject: Diversity and Inclusion Study Services

Project No: W91243-21-Q-TB1S

NAICS Code: NAICS 541611 – Support-Professional: Market Research/Public Opinion

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 the System of Award Management (SAM), https://beta.sam.gov:

CAGE Code:

DUNS Number:

2. Socio-economic status for the listed NAICS code – 541611

Please check all that apply:

( ) Large Business

( ) Small disadvantage business

( ) HUB Zone business

( ) Small Business

( ) 8(a) program participant

( ) 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://beta.sam.gov/, with the socio-economic status identified above and the NAICS code specified in the sources sought notice; or that my firm qualities and registration under the applicable NAICS code is in process.

Name: ______________________________ Date: _______________________________

Title: _______________________________ Signature: ___________________________

3. Examples of similar work:

a. ( ) I have included 3 references of similar work that our firm has performed;

b. ( ) I have not included 3 references of similar work that our firm has performed;

4. Any additional information you would like to provide:

5. 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 FAR Part 19.

https://www.sam.gov/