Service Member and Family Employment and Education Support

SOURCES SOUGHT INFORMATION REQUEST FORM

Project Name: 11199311 Oregon Service Member and Family Employment and Education Program

NAICS Code: 541612 Human Resources Consulting Services

Interested firms please respond with this information form below, and the following requested information. Please complete all sections of the document to ensure appropriate market research and determination of companies' technical capability of business size representation.

1. Company Information:

Company name: _________________________________________________________
Company Address as registered in System for Award Management (SAM) (formally CCR):
________________________________________________________________________________________________________________________________________________

( ) 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/public/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

2. Attachments:
( ) I have attached a positive statement of intent to bid as a prime contractor
( ) I have completed and signed the Sources Sought Information Request Form