(05) Exhibit-A.pdf
PDF 145 KB Posted
- Solicitation number
- 12444225Q0002
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is a Contractor's Financial Information Sheet that requests general business information, ownership details, and responses to financial-related questions. The form collects details such as the contractor's name, business type, taxpayer ID, DUNS number, products/services provided, business size/socioeconomic status, and contact information. It also asks if the contractor has any outstanding debt, judgments, liabilities, or discontinued business operations.
The related federal contract opportunity is a solicitation for Janitorial Services for the Big Piney Ranger District in Hector, AR. The Department of Agriculture Forest Service is seeking a contractor to provide labor, transportation, and supervision to perform janitorial duties at this location. This solicitation is subject to the Service Contract Labor Standards.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFQ 12444225Q0002 Questions and Answers.pdf | ||
| RFQ 12444225Q0002 Questions and Answers.pdf | ||
| (03) Schedule of Items.pdf | ||
| (02) SOW.pdf | ||
| (01) WD 2015-5137 Pope County AR.pdf | ||
| (04) List of Janitorial Products.pdf | ||
| SF1449.pdf | ||
| (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 .