(04) Exhibit A.pdf
PDF 630 KB Posted
- Attached to
- Catahoula Ranger District-WC Janitorial Services
- Solicitation number
- 12444224Q0023
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is Exhibit A: Contractor's Financial Information Sheet, which is part of a Request for Quote (RFQ) for Janitorial services for the Catahoula Ranger District located in Grant parish, Louisiana. The RFQ is issued by the Department of Agriculture Forest Service and is subject to the Service Contract Labor standards. The RFQ includes the following attachments: (01) WD-LA, (02) SOW-PWS, (03) Schedule of Items, (04) Exhibit A, and (05) Exhibit B. Exhibit A requests general company information such as business type, taxpayer ID, contact details, and business classifications. It also includes questions about the contractor's financial status and government indebtedness. Offerors must submit a completed Exhibit A along with their quote in response to the RFQ. The solicitation provides the wage determination rates, details, specifications, and locations of the janitorial services requirement. Quotes must be submitted to the Contracting Officer by the due date and time, and incomplete offers will not be considered.
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Other files
| File | Type | Posted |
|---|---|---|
| 12444224Q0023.pdf | ||
| (03) Schedule of Items.xlsx | XLSX spreadsheet | |
| (05) Exhibit B.pdf | ||
| (01) WD-LA.pdf | ||
| (02) SOW-PWS.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. 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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