(05) Exhibit A.pdf
PDF 145 KB Posted
- Attached to
- Caney Janitorial Services Federal contract opportunity
- Solicitation number
- 12444224Q0017
- Issued by
- Department of Agriculture Forest Service
About this file
This document is an Exhibit A: Contractor's Financial Information Sheet that is part of a federal contract opportunity solicitation. It requests general information about the contractor such as the organization type, taxpayer ID, DUNS number, products/services provided, and business size categorization (e.g. small business, woman-owned, etc.). It also includes financial-related questions about bankruptcy, judgements, delinquent federal debt, and current government financing. This Exhibit A form is one of several attachments to the overall solicitation, which is a Request for Quote (RFQ) for janitorial services at the Caney Ranger District in Louisiana. The solicitation provides details on the service requirements, wage determination, and site visit coordination.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| (01) WD Claiborne-LA.pdf | ||
| (02) SOW.pdf | ||
| (03) Floorplan.pdf | ||
| 12444224Q0017.pdf | ||
| (04) Schedule of Items.xlsx | XLSX spreadsheet | |
| (06) Exhibit B.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 .