CONTACT INFORMATION:

Prefix:

* First Name:

* Last Name:

Suffix:

* Organization Name:

* Address Line 1:

Address Line 2:

* City:

* State:
N/A Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming

* Postal Code:

* Telephone
Please use this format: xxx-xxx-xxxx

* Email:

* Retype Email (for verification):

PROPOSAL INFORMATION:

* Topic Responding To:
122-FA1    12.2-FA1 Creating Spatial Disorientation in Flight Simulation 122-FH1    12.2-FH1 Delivering In-Vehicle Messages in Temporary Work Zones 122-FH2    12.2-FH2 Advanced Rapid Non-destructive test method to determine chemical composition of concrete materials in the field 122-FH3    12.2-FH3 Pedestrian Auto Enforcement Program (PAEP) 122-FH4    12.2-FH4 Tracking of heavy vehicles for estimating heavy load distribution across the highway system and Weigh-In-Motion Calibration 122-FH5    12.2-FH5 Three dimensional mapping of utilities and underground infrastructure for intersection design, repair or reconstruction 122-FR1    12.2-FR1 Small Scale Diesel Generator for Railway Applications 122-FR2    12.2-FR2 System for Prevention of Lens Surface Contamination

* Title:

BUSINESS INFORMATION:

* This business (for statistical purposes):

• Qualifies as a Socially or Economically Disadvantaged Small Business Concern (SBC) as defined in Section II.C of the solicitation:
   Yes        No
• Qualifies as a Woman-Owned Small Business Concern (SBC) as defined in Section II.D of the solicitation:
   Yes        No
• Qualifies as a HUBZone Small Business Concern (SBC) as defined in Section II.G of the solicitation:
   Yes        No

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