(06) Exhibit-A.pdf
PDF 145 KB Posted
- Solicitation number
- 12444225Q0003
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Contractor's Financial Information Sheet (Exhibit A) that collects key business and financial details from potential contractors. The form consists of two main sections: General Information and Government Financial Aid and Indebtedness.
The form requires contractors to provide basic business information including organization type (e.g., sole proprietorship, LLC, corporation), contact details, DUNS number, taxpayer ID, and business classification (e.g., small business, woman-owned, veteran-owned). It also includes sections for ownership information and requires disclosure of any bankruptcy filings, judgments, liens, pending suits, contingent liabilities, or discontinued business operations with outstanding debts. The second section specifically addresses the contractor's relationship with government financing, including questions about federal debt delinquency, government claims, and current government financing arrangements such as bonds, loans, or advance payments. This form appears to be part of a solicitation package for janitorial services at the Ozark-St. Francis National Forest.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFQ 12444225Q0003 Koen Building Janitorial Services questions and answers.pdf | ||
| (02) SOW.pdf | ||
| (03) Schedule of Items.pdf | ||
| (01) WD 2015-5137 Pope County AR.pdf | ||
| (07) Exhibit-B.pdf | ||
| SF1449.pdf | ||
| (04) Koen Map1.pdf | ||
| 12444225Q0003.pdf | ||
| (05) Koen Map2.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 .