Standard Form 1403 - Preaward Survey Of Prospective Contractor (General) - 1988
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1
2PREAWARD SURVEY OF PROSPECTIVE CONTRACTOR
1. SERIAL NO. (For surveying activity use)
OMB NO.: 9000-0011
Expires:
06/30/2013
(GENERAL)
Public reporting burden for this collection of information is estimated to average 24 hours per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the FAR Secretariat (VRS), Office of Federal Acquisition and Regulatory Policy, GSA, Washington, DC
20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0011), Washington, DC 20503.
SECTION I - REQUEST (For Completion by Contracting Office)
2. NAME AND ADDRESS OF SURVEYING ACTIVITY
3. SOLICITATION NO.
4. TOTAL OFFERED PRICE
$
5. TYPE OF CONTRACT
6A. NAME AND ADDRESS OF SECONDARY SURVEY ACTIVITY
7A. NAME AND ADDRESS OF PROSPECTIVE CONTRACTOR
(For surveying activity use)
6B. TELEPHONE NO. (Include AUTOVON, WATS, or FTS, if available)
7B. FIRM'S CONTACT
7C. TELEPHONE NO. (with area code)
8. WILL CONTRACTING OFFICE PARTICIPATE IN SURVEY?
13. NAME AND ADDRESS OF PARENT COMPANY (If applicable)
YES
NO
9. DATE OF REQUEST
10. DATE REPORT REQUIRED
11. PROSPECTIVE CONTRACTOR REPRESENT THAT IT
IS,
IS NOT A
SMALL BUSINESS CONCERN.
12. WALSH-
A. IS NOT APPLICABLE
14A. PLANT AND LOCATION (If different from Item 7, above)
HEALY
B. IS APPLICABLE AND PROSPECTIVE CONTRACTOR
CON
REPRESENTS HIS CLASSIFICATION AS:
ACT
(Check
MANUFACTURER
REGULAR DEALER
applicable
OTHER (Specify)
box(es))
15A. NAME OF REQUESTING ACTIVITY CONTRACTING OFFICER
14B. POINT OF CONTACT
14C. TELEPHONE NO. (with area code)
15B. SIGNATURE
16A. NAME OF CONTACT POINT AT REQUESTING ACTIVITY (If different from Item 15A)
15C. TELEPHONE NO. (Include AUTOVAN, WATS or FTS, if available)
17. RETURN PREAWARD SURVEY TO THIS ADDRESS:
16B. TELEPHONE NO. (Include AUTOVON, WATS, or FTS, if available)
ATTN:
SECTION II - DATA (For Completion by Contracting Office)
18A.
18E. DELIVERY SCHEDULE
18B. NATIONAL STOCK NUMBER
18C. TOTAL
18D. UNIT
ITEM
(NEW) AND NOMENCLATURE
QUANTITY
PRICE
(a)
(b)
(c)
(d)
(e)
NO.
SOLICITED
$
OFFERED
SOLICITED
$
OFFERED
SOLICITED
$
OFFERED
SOLICITED
$
OFFERED
SOLICITED
$
OFFERED
SOLICITED
$
OFFERED
SOLICITED
$
OFFERED
SOLICITED
$
OFFERED
AUTHORIZATION FOR LOCAL REPRODUCTION
STANDARD FORM 1403
(REV. 9-88)
Previous edition is usable.
Prescribed by GSA FAR (48 CFR) 53.209-1(a)
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