(04) Exhibit-A.pdf
PDF 145 KB Posted
- Solicitation number
- 12444224R0004
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is the Contractor's Financial Information Sheet, which is a form that provides general information about the contractor, their business, and financial history. The key details include:
The contractor's name, business type, taxpayer ID, contact information, products/services provided, and business size/socioeconomic status (e.g. small business, woman-owned, etc.). The form also requests information about any financial challenges the contractor has faced, such as bankruptcy, judgments, contingent liabilities, or outstanding government debts. Additionally, it asks if the contractor is currently receiving any government financing or in default on any obligations. This information is likely required as part of the evaluation process for the federal contract opportunity related to Hurricane Zeta disaster recovery efforts for research plots on the Harrison Experimental Forest.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 12444224R0004 Amendment.pdf | ||
| Schedule of Items with pricing Amendment.xlsx | XLSX spreadsheet | |
| Questions and Answers.pdf | ||
| Harrison Experimental Forest Map.pdf | ||
| (02) SOW.pdf | ||
| (05) Exhibit-B.pdf | ||
| (03) Schedule of Items with pricing.xlsx | XLSX spreadsheet | |
| (01) WD Harrison County MS.pdf | ||
| 12444224R0004.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 .