C04b_(02) Exhibit-A_12444026Q0078.pdf
PDF 145 KB Posted
- Solicitation number
- 12444026Q0078
- Issued by
-
Department of Agriculture Forest Service
About this file
This is Exhibit A: Contractor's Financial Information Sheet, a form used to collect comprehensive financial and organizational details from contractors bidding on federal contracts.
Section I requests general company information including legal name, business address, taxpayer identification number, DUNS number, contact information, and description of products or services provided. The form requires contractors to identify their business type and size status, including options for large business, small business, small disadvantaged business, woman-owned small business, emerging small business, veteran small business, service disabled veteran owned small business, Indian small business, Indian SDB, and HUB Zone designations. The ownership information section captures names and titles of partners, principals, and other relevant stakeholders. Section I also includes yes/no questions regarding bankruptcy history, judgments, liens, pending suits, contingent liabilities, and discontinued business operations with outstanding debts.
Section II addresses government financial aid and indebtedness, requiring contractors to disclose delinquency on federal debt under OMB Circular 129, outstanding government claims, current government financing such as bonds or loans, and any pending or current defaults on obligations with banks, financial institutions, suppliers, or other creditors. All affirmative responses require submission of detailed supporting documentation. This form serves as a critical financial screening tool to assess contractor responsibility and financial stability prior to contract award.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| C05_Question and Answers_12444026Q0078.pdf | ||
| C04c_(03) Exhibit-B_12444026Q0078.pdf | ||
| C04f_SF1449_12444026Q0078.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 .