FDIC Solicitation/Award, Form 3700/55

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SOLICITATION/AWARD
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

2. CONTRACT NO.

3. AWARD/EFFECTIVE
DATE

7. FOR SOLICITATION
INFORMATION CALL:

4. ORDER NUMBER

a. NAME

9. ISSUED BY

CODE

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1. REQUISITION NUMBER

PAGE 1 OF

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE
DATE

b. TELEPHONE NUMBER

8. OFFER DUE DATE/
LOCAL TIME

10. SOCIO-ECONOMIC STATUS
YES

NO

SDB
MWOB

ETHNICITY:

SERVICE-DISABLED VETERANOWNED SMALL BUSINESS

13b. N/A

12. DISCOUNT TERMS
13a.

SEE SCHEDULE
15. DELIVER TO

CODE

FACILITY
CODE

TELEPHONE NO.

16. ADMINISTERED BY

Best Value

RFP

Price only

CODE

18a. PAYMENT WILL BE MADE BY

CODE

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK
BELOW IS CHECKED
SEE ADDENDUM

M

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN
OFFER
20.
SCHEDULE OF SUPPLIES/SERVICES

SA

19.
ITEM NO.

14. METHOD OF SOLICITATION
RFP
RFI
RFQ

PL

17a. CONTRACTOR/
OFFEROR

CODE

SUB-CONTRACTING
PERMITTED/APPROVED

E

11. DELIVERY FOR FOB DESTINATION UNLESS BLOCK IS
MARKED

NAICS:

21.
QUANTITY

22.
UNIT

23.
UNIT PRICE

24.
AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25.

N/A

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCLUDES ATTACHMENTS

YES

NO

27b. AWARD INCLUDES ATTACHMENTS

YES

NO

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN
COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY
ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

FDIC 3700/55 (3-08)

DATED
. YOUR OFFER ON SOLICITATION
(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE
SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

31a. FEDERAL DEPOSIT INSURANCE CORPORATION (SIGNATURE OF CO)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER (Type or print)

OFFER

30c. DATE SIGNED

31b. NAME OF CONTRACTING OFFICER (Type or print)

31c. DATE SIGNED

20.
SCHEDULE OF SUPPLIES/SERVICES

21.
QUANTITY

22.
UNIT

23.
UNIT PRICE

24.
AMOUNT

M

PL

E

19.
ITEM NO.

32a. QUANTITY IN COLUMN 21 HAS BEEN
INSPECTED

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

SA

RECEIVED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE

32c. DATE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE

32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER

34. VOUCHER NUMBER

PARTIAL
FINAL
38. S/R ACCOUNT NO.

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

35. AMOUNT VERIFIED
CORRECT FOR

COMPLETE
39. S/R VOUCHER NUMBER

37. CHECK NUMBER

36. PAYMENT
PARTIAL

FINAL

40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT
41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER
41c. DATE

42a. RECEIVED BY (Print)
42b. RECEIVED AT (Location)
42c. DATE REC'D (YY/MM/DD)

42d. TOTAL CONTAINERS

FDIC 3700/55 (3-08) Page 2

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