12-PA2050 Business Disclosure Form.dotx.pdf

It is recommended this form be completed by a governing person, governing authority, or legal counsel.

Information about Entity Submitting Bid/Proposal/Offer (This information must match the information provided on the Bid/Proposal/Offer.)

Business Name:

Business Address: Mailing Address:

City State Zip City State Zip

Business Web Address:

Business Phone: Business Fax:

Contact Person: Contact’s Phone No.:

Contact’s E-Mail Address:

I. Entity Ownership Information (Check the appropriate box and provide requested details below.)

Business Structure: (Please check only one box)

Partnership Limited Partnership Limited Liability Partnership

Sole Proprietorship Joint Venture Limited Liability Company Corporation (“C”)

IF CORPORATION, please check all the type(s) below that are applicable:

For Profit or Non Profit Public or Private

S Corporation Professional Parent-Subsidiary Close

State of Incorporation, Registration or Formation:

State: Month: Year:

Name(s) of Owner(s) or Partners (or Owner of DBA if applicable) Please indicate if any such individual(s) were employed by DFW Airport and the dates employed:

Name of Joint Venture Participants, if applicable Please indicate if any such individual(s) were employed by DFW Airport and the dates employed:

UNLESS PUBLICLY TRADED list all individuals, partnerships, corporations or other entities having at least 10% ownership in the business and indicate their percentage of ownership. Please indicate if any such individual(s) were employed by DFW Airport and the dates employed. Attach additional sheets if necessary.

Form Completion Date:

Failure to properly complete and submit this form with the bid/proposal/offer may cause the bid/ proposal/offer to be considered non-responsive.

Form Revised 10/13

DALLAS-FORT WORTH INTERNATIONAL AIRPORT BOARD

BUSINESS DISCLOSURE FORM