1.Sources_Sought_Information_Request_Form_17May2017.pdf

SOURCES SOUGHT INFORMATION REQUEST FORM

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:

Address as registered in System for Award Management (SAM):

CAGE Code:

DUNS Number:

Socioeconomic status for the listed NAICS code - Please check all that apply:

______ By initialing this line, I confirm that my firm is registered in the System for Award Management (SAM) website (https://www.sam.gov) with the socioeconomic status identified above and the NAICS code specified in the sources sought notice; or that my firm qualifies and registration under the applicable NAICS code is in process.

Large Business

Small Disadvantaged Business

HUB Zone Business

Service-Disabled Veteran-Owned Small Business (SDVOSB)

8(a) Program Participant

Woman-Owned Business

Small Business

2. BONDING CAPABILITY

By responding to this Sources Sought Notice, I CONFIRM my firm, individually and/or through association with joint ventures or teaming partners, has bonding capability of amounts filled in below.

Individual Project Bonding:

Total Aggregate Bonding Capability:

3. 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 Part 19 of the Federal Acquisition Regulation.

PRINT NAME/TITLE:

PHONE:

EMAIL:

SIGNATURE: