(05) Exhibit-A.pdf
PDF 145 KB Posted
- Attached to
- Janitorial, Solid Waste Removal, and Ground Maintenance Services for Poteau Ranger District
- Solicitation number
- 12444225Q0011
- Issued by
-
Department of Agriculture Forest Service
About this file
Exhibit A is a Contractor's Financial Information Sheet designed to collect comprehensive business and financial details for a potential federal contract. The document requires contractors to provide general information including business type (options range from Sole Proprietorship to LLC), taxpayer ID, DUNS number, contact information, and business classification (such as Small Business, Woman Owned Small Business, Veteran Small Business).
The form also includes critical financial disclosure sections requiring contractors to reveal information about potential financial risks, including bankruptcy history, outstanding judgments, contingent liabilities, and government debt status. Contractors must disclose whether they have filed for bankruptcy, have pending legal suits, are delinquent on federal debt, currently receive government financing, or are in default on any financial obligations. The form is structured to comprehensively assess a contractor's financial stability and potential risk factors for a federal contract opportunity, in this case related to Janitorial, Solid Waste Removal, and Ground Maintenance Services for the Poteau Ranger District.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| (03) Schedule of Items.xlsx | XLSX spreadsheet | |
| (01) WD Scott County AR.pdf | ||
| (06) Exhibit-B.pdf | ||
| (04) SOW.pdf | ||
| (02) Mowing and Brush Hogging Area Map.pdf | ||
| SF1449.pdf | ||
| 12444225Q0011.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 .