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1. REQUISITION NO.SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS OFFER OR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 2. CONTRACT NO.3. AWARD/EFFECTIVE DATE7. FOR SOLICITATION INFORMATION CALL:a. NAMESAKE

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va248-12-r-0898 is a specific form used for reporting certain financial or demographic information as required by state regulations.

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