Attachment 007 Exhibit A CON FIN INFO SHEET FILLABLE.pdf
PDF 181 KB Posted
- Solicitation number
- 12445124R0004
About this file
This document outlines requirements for multiple indefinite delivery/indefinite quantity contracts for road construction and maintenance services. The U.S. Department of Agriculture Forest Service intends to award up to four contracts valued at a maximum of $3 million each to provide road construction and maintenance activities across multiple projects in Mississippi. The scope of work includes tasks such as grading, surface repair, ditch cleaning and reshaping, roadside mowing and seeding, and machine placement of riprap and rock. Construction services will also include slide removal, culvert replacement, and ditch reconstruction. The contracts are set aside exclusively for small businesses and will have a base period of one year with an optional two-year extension. The primary user will be the USDA Forest Service across the Mississippi National Forest, and other USDA agencies may also utilize the contracts within the state.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Road Construction Services
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. SAM UNIQUE ID 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.
Solicitation Number:
Forest/State:
| 2 TYPE OF ORGANIZATION CHECK ONE1ANAME: |
| A Sole Propr etorship: |
| 2 TYPE OF ORGANIZATION CHECK ONE1B STREET ADDRESS: |
| B General Partnersh p: |
| 2 TYPE OF ORGANIZATION CHECK ONE1B STREET ADDRESS_2: |
| C Lim ted Partnership: |
| 1C CITY: |
| 1D STATE: |
| 2 TYPE OF ORGANIZATION CHECK ONE1E ZIPPOSTAL: |
| 2 TYPE OF ORGANIZATION CHECK ONE1E ZIPPOSTAL_2: |
| 2 TYPE OF ORGANIZATION CHECK ONERow4: |
| I Other Spec fy: |
| 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 BUSINESSSpec fy one block plus J f app cab eRow1: |
| A LARGE BUSINESS: |
| E EMERGING SMALL BUSINESS: |
| 10 KIND OF BUSINESSSpec fy one block plus J f app cab eRow2: |
| B SMALL BUSINESS: |
| F VETERAN SMALL BUSINESS: |
| 10 KIND OF BUSINESSSpec fy one block plus J f app cab eRow3: |
| C SMALL DISADVANTAGED BUSINESS: |
| 10 KIND OF BUSINESSSpec fy one block plus J f app cab eRow4: |
| D WOMAN OWNED SMALL BUSINESS: |
| 10 KIND OF BUSINESSSpec fy one block plus J f app cab eRow3_2: |
| K Other P ease Spec fy: |
| TITLE12: |
| TITLE13: |
| TITLE14: |
| TITLE15: |
| YesA Have youyour aff ates ever f ed for bankruptcy: |
| NoA Have youyour aff ates ever f ed for bankruptcy: |
| YesB Do you have any udgments ens pending suits: |
| NoB Do you have any udgments ens pending suits: |
| YesC Do you have any cont ngent abi t es: |
| NoC Do you have any cont ngent abi t es: |
| YesD Have youyour aff ates discont nued bus ness operat ons w th outstanding debts: |
| NoD Have youyour aff ates discont nued bus ness operat ons w th outstanding debts: |
| Yes17 Are you del nquent on any Federal Debt OMB C rcular 129: |
| No17 Are you del nquent on any Federal Debt OMB C rcular 129: |
| Yes18 Do you owe the Government for any contract or other c a ms: |
| No18 Do you owe the Government for any contract or other c a ms: |
| Yes19 Are you current y receiv ng Government F nanc ng Bonds Loans Advanced Payments Progress Payments Other: |
| No19 Are you current y receiv ng Government F nanc ng Bonds Loans Advanced Payments Progress Payments Other: |
| Yes19a Are you now n or pending Default on ANY Ob gat ons e Banks F nanc a Inst tut ons Suppl ers Other IF yes please attach deta ed nformat on: |
| No19a Are you now n or pending Default on ANY Ob gat ons e Banks F nanc a Inst tut ons Suppl ers Other IF yes please attach deta ed nformat on: |
| Text1: |
| Text2: |
| Text3: |
| Text4: |
| Text5: |
| Text6: |
| Text7: |
| Text8: |
| Text9: |
File details come from the government source that posted it. Updated .