(06) Exhibit-A.pdf
PDF 145 KB Posted
- Solicitation number
- 12444225Q0025
- Issued by
-
Department of Agriculture Forest Service
About this file
Exhibit A is a Contractor's Financial Information Sheet for a federal solicitation related to Ground Maintenance Services for the Big Piney Ranger District. The form captures comprehensive financial and organizational details about a potential contractor, including business type, contact information, ownership structure, and financial status.
The document requires the contractor to provide details such as business classification (options include Small Business, Woman-Owned Small Business, Veteran Small Business, etc.), DUNS number, and contact information. Critically, the form includes sections that probe the contractor's financial health, requiring disclosure of potential bankruptcy, outstanding judgments, liens, contingent liabilities, and any delinquencies on federal debt or government contracts. The form is designed to assess the financial stability and reliability of potential contractors bidding on the ground maintenance service solicitation for the Department of Agriculture Forest Service.
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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 .