Form SF1403 Pre-Award Survey of Prospective Contractor - General

PREAWARD SURVEY OF PROSPECTIVE CONTRACTOR
(GENERAL)

1. SERIAL NUMBER (For surveying activity use) OMB Control Number: 9000-0011

Expiration Date: 12/31/2020

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act
of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for
this collection is 9000-0011. We estimate that it will take 24 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to
our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: U.S. General Services Administration,
Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

SECTION I - REQUEST (For Completion by Contracting Office)

2. NAME AND ADDRESS OF SURVEYING ACTIVITY

3. SOLICITATION NUMBER

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 NUMBER (Include AUTOVON, WATS, or FTS, if available)

7B. FIRM'S CONTACT

8. WILL CONTRACTING OFFICE PARTICIPATE IN SURVEY?

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

YES

7C. TELEPHONE NUMBER (with area code)

NO

9. DATE OF REQUEST

10. DATE REPORT REQUIRED

11. PROSPECTIVE CONTRACTOR REPRESENT THAT IT

IS,

IS NOT A

SMALL BUSINESS CONCERN.
12. WALSHA. IS NOT APPLICABLE
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

15B. SIGNATURE

16A. NAME OF CONTACT POINT AT REQUESTING ACTIVITY (If different from Item 15A)

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

14C. TELEPHONE NUMBER (with area code)

15C. TELEPHONE NUMBER (Include AUTOVAN, WATS or FTS, if available)
17. RETURN PREAWARD SURVEY TO THIS ADDRESS:

ATTENTION:
18A.
ITEM
NO.

16B. TELEPHONE NUMBER (Include AUTOVON, WATS, or FTS, if available)

SECTION II - DATA (For Completion by Contracting Office)

18B. NATIONAL STOCK NUMBER
(NEW) AND NOMENCLATURE

18C. TOTAL
QUANTITY
SOLICITED
OFFERED
SOLICITED
OFFERED
SOLICITED
OFFERED
SOLICITED
OFFERED
SOLICITED
OFFERED
SOLICITED
OFFERED
SOLICITED
OFFERED
SOLICITED
OFFERED

AUTHORIZED FOR LOCAL REPRODUCTION
Previous edition is NOT usable

18D. UNIT
PRICE

18E. DELIVERY SCHEDULE
(a)

(b)

(c)

(d)

(e)

$
$
$
$
$
$
$
$

STANDARD FORM 1403 (REV. 1/2014)
Prescribed by GSA FAR (48 CFR) 53.209-1(a)

SECTION III - FACTORS TO BE INVESTIGATED

UNCHK. SAT. SAT.
(c)
(a)
(b)

19. MAJOR FACTORS

20. OTHER FACTORS
(Provide specific requirements in Remarks)

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 surveying activity)

F. ENVIRONMENTAL/ENERGY CONSIDERATION

YES

UNCHK. SAT. SAT.
(c)
(a)
(b)

G. FLIGHT OPERATIONS/FLIGHT SAFETY

NO

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

H. OTHER
(Specify)

NO
YES
23. REMARKS (For Contracting Activity Use)

SECTION IV - SURVEYING ACTIVITY RECOMMENDATIONS
24. RECOMMEND

25A. NAME AND TITLE OF SURVEY APPROVING OFFICIAL

25B. TELEPHONE NUMBER

25C. SIGNATURE

25D. DATE

A. COMPLETE AWARD
B. PARTIAL AWARD
(Quantity

)

C. NO AWARD

STANDARD FORM 1403 (REV. 1/2014) BACK