PREAWARD SURVEY OF PROSPECTIVE CONTRACTOR
(GENERAL)

1. SERIAL NO. (For surveying activity use)           

OMB NO.:9000-0011
Expires: 10/31/97

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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
(For surveying activity use)

7A. NAME AND ADDRESS OF PROSPECTIVE CONTRACTOR

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?
 YES  NO

13. NAME AND ADDRESS OF PARENT COMPANY (If applicable)

9. DATE OF REQUEST

10. DATE REPORT REQUIRED

11. PROSPECTIVE CONTRACTOR REPRESENT THAT IT  IS,  IS NOT A SMALL BUSINESS CONCERN.

A. IS NOT APPLICABLE

14A. PLANT AND LOCATION (If different from Item 7, above)

12. WALSH-HEALY CON ACT (Check applicable box(es))

B. IS APPLICABLE AND PROSPECTIVE CONTRACTOR REPRESENTS HIS CLASSIFICATION AS:

 MANUFACTURER  REGULAR DEALER
 OTHER (Specify)

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:

ATTN:

16B. TELEPHONE NO. (Include AUTOVON, WATS, or FTS, if available)

SECTION II - DATA (For Completion by Conracting Office)

18E. DELIVERY SCHEDULE

18A. ITEM
NO.

18B. NATIONAL STOCK NUMBER (NEW) AND NOMENCLATURE

18C. TOTAL QUANTITY

18D. UNIT
PRICE

(a)

(b)

(c)

(d)

(e)

SOLICITED

OFFERED

$

SOLICITED

OFFERED

$

SOLICITED

OFFERED

$

SOLICITED

OFFERED

$

SOLICITED

OFFERED

$

SOLICITED

OFFERED

$

SOLICITED

OFFERED

$

SOLICITED

OFFERED

$

SECTION III - FACTORS TO BE INVESTIGATED

19. MAJOR FACTORS

CHK.
(a)

SAT.
(b)

UN-SAT.
(c)

20. OTHER FACTORS
(Provide specific requirements in Remarks)

CHK.
(a)

SAT.
(b)

UN-SAT.
(c)

A. TECHNICAL CAPABILITY

A.GOVERNMENT PROPERTY CONTROL

B. PRODUCTION CAPABILITY

B. TRANSPORTATION

C. QUALITY ASSURANCE CAPABILITY

C. PACKAGING

D. FINANCIAL CAPABILITY

D. SECURITY

E. ACCOUNTING SYSTEM

E. SAFETY

21. IS THIS A SHORT FORM PREAWARD REPORT? (For completion by contracting activity)

F. ENVIRONMENTAL/ENERGY CONSIDERATION

 YES  NO

G. FLIGHT OPERATIONS/FLIGHT SAFETY

22. IS A FINANCIAL ASSISTANCE PAYMENT PROVISION IN THE SOLICITATION? (For completion by contracting activity)

H.OTHER

(Specify)

 YES  NO

23. REMARKS (For Contracting Activity Use)

SECTION IV - SURVEYING ACTIVITY RECOMMENDATIONS

24. RECOMMEND

25A. NAME AND TITLE OF SURVEY APPROVING OFFICIAL

25B. TELEPHONE NO.

 A. COMPLETE AWARD

 A. PARTIAL AWARD

(Quantity _____________________ )

 A. NO AWARD

25C. SIGNATURE

25D. DATE

AUTHORIZATION FOR LOCAL REPRODUCTION
Previous edition is usable.

STANDARD FORM 1403 (REV 9-88)
Prescribed by GSA FAR (48 CFR) 53.209-1(a)