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