(03) Exhibit-A.pdf
PDF 145 KB Posted
- Solicitation number
- 12444226Q0002
- Issued by
-
Department of Agriculture Forest Service
About this file
This is Exhibit A: Contractor's Financial Information Sheet, a standard federal contracting form designed to collect comprehensive financial and organizational data from potential contractors or current contractors bidding on government opportunities.
Section I requests general company information including legal name, street address, city, state, and ZIP code, along with taxpayer identification number, DUNS number, and contact details (phone, fax, and email). Contractors must specify their type of organization, selecting from options including sole proprietorship, general partnership, limited partnership, corporation, subchapter S corporation, LLC, joint venture, non-profit/education institution, or other entity types. The form also requires identification of the primary kind of product or service provided and classification of business status, including options for large business, small business, small disadvantaged business, woman-owned small business, emerging small business, veteran small business, service-disabled veteran-owned small business, Indian small business, Indian SDB, and HUB Zone certifications. Section I further requires listing of ownership information for partners, principals, and other key individuals with their titles, and includes yes/no questions regarding bankruptcy history, judgments, liens, pending suits, contingent liabilities, and discontinued business operations with outstanding debts.
Section II addresses government financial relationships and indebtedness, requiring disclosure of delinquency on federal debt per OMB Circular 129, amounts owed to the government for contracts or claims, current receipt of government financing (bonds, loans, advanced payments, progress payments, or other forms), and any defaults or pending defaults on obligations with banks, financial institutions, suppliers, or other entities. Any affirmative responses require submission of detailed supporting documentation.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 12444226Q0002 Additional Questions and Answers.pdf | ||
| 12444226Q0002 Questions and Answers.pdf | ||
| (02)SOW.pdf | ||
| 12444226Q0002.pdf | ||
| (04) Exhibit-B.pdf | ||
| (01)WD Franklin County MS.pdf | ||
| SF1449.pdf |
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Text version
Exhibit A: CONTRACTOR’S FINANCIAL INFORMATION SHEET
SECTION 1 – GENERAL INFORMATION
1A.NAME 2. TYPE OF ORGANIZATION (CHECK ONE)
A. Sole Proprietorship F. LLC
1B. STREET ADDRESS B. General Partnership
G. Joint Venture C. Limited Partnership H. Non-Profit/Education
1C. CITY 1D. STATE 1E. ZIP/POSTAL D. Corporation I. Other: Specify E. Subchapter S.
3. TAXPAYER ID NUMBER : 4. PHONE NUMBER 5. FAX NUMBER
6. DUNS NUMBER: 7. CELLPHONE NUMBER
8. KIND OF PRODUCT OR SERVICE PROVIDED: 9. EMAIL ADDRESS
10. KIND OF BUSINESS- Specify one block (plus “J” if applicable)
A. LARGE BUSINESS E. EMERGING SMALL
BUSINESS
I. INDIAN SDB
B. SMALL BUSINESS F. VETERAN SMALL BUSINESS J. HUB ZONE - Also
C. SMALL DISADVANTAGED BUSINESS G. SERVICE DISABLED
VETERAN OWNED SMALL
BUSINESS
K. Other: Please Specify
D. WOMAN OWNED SMALL BUSINESS H. INDIAN SMALL BUSINESS
11. OWNERSHIP INFORMATION – PARTNERS – PRINCIPALS - OTHERS
NAME TITLE
13.
14.
15.
16. Questions. If “Yes” to any below, attach detailed information. Yes No A. Have you/your affiliates ever filed for bankruptcy?
B. Do you have any judgments, liens, pending suits?
C. Do you have any contingent liabilities?
D. Have you/your affiliates discontinued business operations with outstanding debts?
SECTION II. GOVERNMENT FINANCIAL AID AND INDEBTEDNESS
If “Yes”, attach detailed information.
Yes No
17. Are you delinquent on any Federal Debt (OMB Circular 129)
18. Do you owe the Government for any contract or other claims?
19. Are you currently receiving Government Financing? (Bonds, Loans, Advanced Payments, Progress Payments, Other)
19a. Are you now in or pending Default on ANY Obligations (i.e. Banks, Financial Institutions, Suppliers, Other)? IF yes please attach detailed information.
File details come from the government source that posted it. Updated .