SHEET P

Evaluation criteria is Lowest Price Technically Acceptable (LPTA). PPIRS will be used to determine vendor responsibility. Potential contractors will be screened for responsibility in accordance with FAR 9.104. Please fill out HMDRFQINFO on pages 33-35 of the solicitation.

YOUR COMPANY INFORMATION YOUR BUSINESS SIZE:

Large (LG),

Small (SB),

Small-Disadvantaged Business (SDB),

Veteran-Owned Small Business (VOSB),

Women-Owned Small Business (WOSB),

Economically Disadvantaged Women-Owned Small Business (EDWOSB),

Service Disabled Veteran Owned Small Business (SDOVSB),

(HUBZONE),

(8a). QUOTING AS MANUFACTURER? Yes

No

Name of Quoted Manufacturer

QUOTING AS:

AUTHORIZED DISTRIBUTOR or

THIRD PARTY DEALER Do you have dealer independence? Yes

No

(does the MFR set your prices)

SAM CAGE CODE of MFR:

SHIPPING INFORMATION PLACE OF MFG/COUNTRY OF ORIGIN:

/

ESTIMATED DELIVERY TO PEARL HARBOR

Calendar Days ARO FOB TERMS:

DESTINATION SHIP TO:

DoDAAC:

N32253 Country Code: USA PEARL HARBOR NAVAL SHIPYARD IMF 667 SAFEGUARD STREET, BLDG 167-1 RECV 808- 473-8000X4961 PEARL HARBOR, HI 96860-5033 UNITED STATES Government Representative, DLA Distribution Email: distrcustomerservice@dla.mil Phone: 808-473-8000 X4961