(04) Exhibit A.pdf
PDF 630 KB Posted
- Attached to
- Sam Houston RD Janitorial Services Federal contract opportunity
- Solicitation number
- 12444224Q0033
- Issued by
- Department of Agriculture Forest Service
About this file
This document is the Contractor's Financial Information Sheet, which is Exhibit A in a federal contracting opportunity. It requests general information about the contractor such as business type, taxpayer ID, contact details, and products/services provided. It also asks about the contractor's financial status, including any bankruptcy filings, judgments, liens, contingent liabilities, or discontinued business operations. The contractor must provide details on any government financing, delinquent federal debt, or pending defaults. This financial information sheet is likely required as part of the solicitation package for a janitorial services contract for the Sam Houston Ranger District in Texas. The solicitation includes a Statement of Work, Schedule of Items, and additional exhibits which provide the full details and requirements for this opportunity.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 12444224Q0033.pdf | ||
| (02) SOW.pdf | ||
| (03) Schedule of Items.xlsx | XLSX spreadsheet | |
| (05) Exhibit B.pdf | ||
| (01) WD-TX.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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