Sources Sought CONTRACTOR FORM Fillable

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

for

VHA | RPOC | NETWORK CONTRACTING OFFICE 15

Use this form to provide contractor’s general information. Please limit response to one page. The box at the bottom of this form may be used to clarify any requested information.

1. Contractor Information:

Business Name:
Address:

SAM UEI:

Name of POC for Business:
Phone Number of POC:

Email of POC:

2. Type of Business: (check all that apply)
SBA certified 8(a) firm

SBA certified HUBZone Small Business

Service‐Disabled Veteran‐Owned Small Business

Veteran‐Owned Small Business

Economically Disadvantaged Women‐Owned Small Business

Women‐Owned Small Business

Large Business

3. Please identify number of projects your organization has performed at the different ranges identified below:
<$500K

$500K ~ $1M

$1M ~ $2M

$2M ~ $5M

>$5m

4. CAPABILITIES STATEMENT: