Sources Sought Information Request Form.doc

Sources Sought Information Request Form - Page 1 of 2

Project Name:

Bonding requirement:

NAICS Code:

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 CCR:

FORMCHECKBOX

I have confirmed that my address listed above is exactly the same as listed in CCR

FORMCHECKBOX

The above address is not the same in CCR, 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

FORMCHECKBOX

Small disadvantaged business

FORMCHECKBOX

8(a) program participant

FORMCHECKBOX

HUB Zone business

FORMCHECKBOX

Woman-Owned business

FORMCHECKBOX

Service-Disabled Veteran-Owned Small Business (SDVOSB)

The firm must be registered in CCR (www.CCR.gov) with the socio-economic status identified above and the NAICS code specified in the sources sought notice. If the firm’s CCR record does not include this project’s NAICS code, the firm will not be considered.

FORMCHECKBOX

I have confirmed that my firm is registered in CCR for the NAICS code and business type selected

FORMCHECKBOX

My firm is not registered in CCR with the NAICS code and business status selected, but the firm qualifies and registration is in process

FORMCHECKBOX

My firm is not registered in CCR 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

FORMCHECKBOX

My firm does not have a bonding capacity letter

FORMCHECKBOX

My firm cannot bond to the stated bond requirement

3. Examples of similar work:

FORMCHECKBOX

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

FORMCHECKBOX

I have not attached three references of similar work that our firm has performed.

Sources Sought Information Request Form - Page 2 of 2

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.

Name:

Title:

Phone Number: