(05) Exhibit A.pdf
PDF 630 KB Posted
- Solicitation number
- 12444225Q0004
- Issued by
-
Department of Agriculture Forest Service
About this file
This is Exhibit A, a Contractor's Financial Information Sheet that appears to be a required form for the Caddo-LBJ National Grasslands janitorial services solicitation. The form collects basic business information including company name, address, contact details, taxpayer ID, SAM Unique Entity Identifier, and business size classification (large, small, woman-owned, veteran-owned, etc.).
The form requires disclosure of ownership information and contains several yes/no questions about bankruptcy history, judgments, liens, pending suits, contingent liabilities, and discontinued business operations. It also includes a section on government financial aid and indebtedness, asking about delinquent federal debt, government claims, current government financing, and any pending defaults on obligations. This appears to be a standard financial disclosure form used to assess contractor responsibility and financial capability.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| (01) WD-TX.pdf | ||
| (06) Exhibit B.pdf | ||
| (04) Contractor Items-Personnel.xlsx | XLSX spreadsheet | |
| 12444225Q0004.pdf | ||
| (03) Schedule of Items.xlsx | XLSX spreadsheet | |
| (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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File details come from the government source that posted it. Updated .