Financial_Information.pdf
PDF 125 KB Posted
- Attached to
- Design/Build Bridge Repairs Federal contract opportunity
- Solicitation number
- 127K1119R0002
About this file
Financial Information Form
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| L01-1.0_CFR.PDF | ||
| 339-1.3_INSP_190212.pdf | ||
| PERFORMANCE_RELEVANCY_QUESTIONNAIRE.pdf | ||
| DBWD_Winn.pdf | ||
| 231-1.3_INSP_190315.pdf | ||
| DBWD_Grant.pdf | ||
| Solicitation_127K1119R0002.pdf | ||
| 287-7.1_INSP_190319.pdf | ||
| DBWD_Vernon.pdf | ||
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Text version
127K1119R0002 ATTACHMENT 10
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.
127K1119R0002 ATTACHMENT 10
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