(04) Exhibit A.pdf

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Attached to
Fire Command Vehicle Upfit Services-Daniel Boone NF Federal contract opportunity
Solicitation number
12443926Q0020
Issued by
Department of Agriculture Forest Service

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This is a Contractor's Financial Information Sheet template used to collect comprehensive financial and organizational data from potential federal contractors during the solicitation process.

Section I requires general company information including legal name, business address, taxpayer identification number, SAM Unique Entity Identifier, and contact details. Contractors must identify their organizational type (sole proprietorship, corporation, LLC, joint venture, non-profit, or other) and specify their primary business classification category, including small business designations such as small disadvantaged business (SDB), woman-owned small business (WOSB), veteran-owned small business (VOSB), service-disabled veteran-owned small business (SDVOSB), HUB Zone, and Indian small business classifications. The form also requires disclosure of ownership information for partners, principals, and other key stakeholders, and includes yes/no questions regarding bankruptcy history, judgments, liens, pending litigation, and contingent liabilities.

Section II addresses government financial relationships and indebtedness, requiring disclosure of federal debt delinquency status, outstanding government claims, current government financing (bonds, loans, advanced payments, progress payments), and any defaults or pending defaults with banks, financial institutions, suppliers, or other obligors. All affirmative responses require submission of detailed supporting documentation. This form serves as a due diligence tool to assess contractor financial stability and eligibility for federal contract award.

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Other files for this federal contract opportunity

Other files attached to Fire Command Vehicle Upfit Services-Daniel Boone NF, newest first.
File Type Posted
(03) Schedule of Items.xlsx XLSX spreadsheet
(05) Exhibit B.pdf PDF
12443926Q0020.pdf PDF
(02) SOW.pdf PDF
(01) WD-KY.pdf PDF

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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. SAM Unique Entity Identifier: 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.

https://sam.gov/content/duns-uei

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