Attachment 5 Contractors Financial Info.docx
DOCX document 24 KB Posted
- Solicitation number
- 12447U20R0002
About this file
This document includes an attachment requesting financial information from contractors as well as details of a related federal contract opportunity for road maintenance services. The National Forests in Mississippi is soliciting proposals for indefinite-delivery, indefinite-quantity contracts to provide all materials, labor, equipment, tools, and other resources necessary for road maintenance on system roads within its boundaries. The base period of performance is from date of award through March 31, 2021, with two optional one-year extensions. This 100% small business set-aside requires contractors to submit financial information including organization type, tax identification number, and responses to questions regarding bankruptcy, judgments, contingent liabilities, and government debt or financing. The solicitation and related documents will be available for download on March 3, 2020 via beta.SAM.gov; no hard copies will be distributed. Interested vendors should monitor the site for notifications and award is based on best value to the government.
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Road Maintenance IDIQ 12447U20R0002 National Forests in Mississippi
ATTACHMENT 5
CONTRACTOR’S FINANCIAL INFORMATION
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. FFIS VENDOR CODE: (FS VENDORS) |
| 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. WOMAN OWNED SDB
I. INDIAN SDB
B. SMALL BUSINESS
F. VETERAN SMALL BUSINESS
J. HUB ZONE - Also
C. SMALL DISADVANTAGED BUSINESS
G. VETERAN SDB
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, provide detailed information in section vii, remarks. |
| 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” provide detailed information in Section VII, remarks.
| 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 provide detailed information in Section VII remarks.
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