W912BV23SSCW1 INFO SHEET.pdf

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Occupational Health Clinic Medical Surveillance Services (MEDSERV)
Solicitation number
W912BV23SSCW1
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Name ________________________________________________________________________________________

Address ______________________________________________________________________________________

Phone _______________________________________________________________________________________

Point of contact (POC) _________________________________________________________________________

POC email address ____________________________________________________________________________

Your firm’s 12-character Unique Entity Identifier (UEI) ____________________________________________

CAGE Code __________________________________________________________________________________

Your Firms SPRS/NIST Score ___________________________________________________________________

SAM Registration Expiration Date _______________________________________________________________

Your firm’s socioeconomic category for NAICS code 61111 (****SEE BELOW) _________________________

****Do not list a category that is not depicted in the chart on the first page of this Sources Sought. If your

Small Business category is not listed in the chart below, please select SB. We will be able to view additional information on you SAM Registration.

ACRONYM CHART OF APPLICABLE SMALL BUSINESS CATEGORIES

SB Small Business Firms 8(a) SBA Certified 8(a) Program Participants

HUBZone SBA Certified HUBZone Firms SDVOSB Service-Disabled Veteran Owned Small Business (SDVOSB) Firms

WOSB Woman-Owned Small Businesses (WOSB) Firms EDWOSB Economically Disadvantaged Women-Owned Small Business (EDWOSB) Firms

The anticipated NACIS is: 621111. If you believe this project would be better suited under a different NAICS, please provide it _______________________________________________________________________________

Provide NO MORE THAN TWO (2) 8.5X11 PAGES OF ADDITIONAL INFORMATION YOU MAY WISH TO

SHARE ABOUT YOUR INTEREST IN THIS ANTICIPATED REQUIREMENT, INCLUDING ANY

ILLUSTRATION OR EXAMPLES OF PAST WORK DEMONSTRATING YOUR FIRM’S ABILITY TO MEET

THE ANTICIPATED REQUIREMENT. Do not include graphics or other non-text information. Do not use font smaller than 10pt.

A DRAFT PERFORMANCE WORK STATEMENT IS PROVIDED AS A SEPARATE ATTACHMENT.

Name:
Address:
Phone:
Point of contact POC:
POC email address:
Your firms 12character Unique Entity Identifier UEI:
CAGE Code:
Your Firms SPRSNIST Score:
SAM Registration Expiration Date:
Your firms socioeconomic category for NAICS code 61111 SEE BELOW:
please provide it:

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