SOLICITATION FOR OFFERS
OUTPATIENT CLINIC
SFO NO. V101-183R-xxx-xxx-xx
[INSERT LOCATION OF FACILITY]
20. LIST OF ATTACHMENTS SUBMITTED WITH THIS OFFER (See solicitation requirements)
21. ALTERNATES - ADDITIONAL REMARKS OR CONDITIONS WITH RESPECT TO THIS OFFER
SECTION IV - OWNER IDENTIFICATION AND CERTIFICATION
22. RECORDED OWNER (Name and address including ZIP code)
23. OWNER OPERATES AS A(N)
INDIVIDUAL
PARTNERSHIP
CORPORATION
(Specify State):
24. OFFEROR (Name and address including ZIP code)
25. OFFEROR'S INTEREST IN PROPERTY
OWNER
AGENT
OTHER
(Specify):
a. Addendum No.
b. Date Received
26. The Offeror agrees upon acceptance of this proposal by the herein specified date, to lease to the
United States of America, the premises described, upon the terms and conditions as specified herein,
in full compliance with and acceptance of the aforementioned Solicitation, with attachments.
a. TYPED NAME AND TITLE
b. TELEPHONE NUMBER
(Include area code)
27. OFFEROR
c. SIGNATURE
d. DATE SIGNED
PAGE 2 OF 2
GSA FORM 1364 (REV 5/98)
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