7_-_Contractor_Business_Qualifications.pdf

Section J – Attachment #7

United States Marshals Service – Prisoner Operations Division Contractor Business Qualifications

Policy:

Federal Acquisition Regulation (FAR), subpart 9.103 prescribes “contracts shall be awarded to, responsible prospective contractors only.”

The policy of the United States Marshals Service (USMS) and the Prisoner Operations Division (POD) in acquiring supplies or services is to require prospective contractors engaged in conducting business with this office to affirmatively demonstrate their responsibility.

Applicability:

This requirement applies to all proposed contracts with any prospective contractor that is located:

(1) In the United States, its possessions, or Puerto Rico; or

(2) Elsewhere, unless application of the subpart would be inconsistent with the laws or customers where the contractor is located.

The attached questionnaire shall be completed by prospective contractors. The questionnaire is one tool POD will use to determine contractor responsibility.

Definitions:

(a) "Principals" are those individuals in a firm who possess legal responsibility for its management.

They may be officers, directors, owners, partners, and persons having primary management or supervisory responsibilities within a business entity (e.g., general manager, plant manager, head of a subsidiary, division or business segment, and similar positions).

(b) "Parent Company" is that firm, company, corporation, association, or conglomerate which is the major stockholder or highest tier owner of the firm completing the questionnaire; (i.e., Firm A is owned by Firm B which is, in turn, a subsidiary of Corporation C. The "parent company" is Corporation C).

(c) "Joint Venture" is a collaborative undertaking by two or more firms or individuals for which the participants are both jointly and individually responsible.

(d) "Consultant" as used in this questionnaire, is a highly specialized individual or firm having significant input and responsibility for certain aspects of a project and possessing unusual or unique capabilities for assuring success of the finished work.

(e) "Specialists and Individual Consultants" as used in this questionnaire, refer to individuals who have major project responsibility, or will provide unusual or unique capabilities for the services under consideration.

CONTRACTOR QUALIFICATION QUESTIONNAIRE

1. Organization Name:

2. Under what other or former names has your organization operated?

3. If your organization is a corporation, provide the following:

(i) Date of incorporation: _________________

(ii) State of incorporation: ________________

(iii) Identify President (CEO), Vice President, Treasurer and Secretary (include Date of Birth, Place of Birth, Social Security Number, Race and Gender):

4. If your organization is a partnership, provide the following:

(i) Date of organization: _______________________

(ii) Type of partnership (if applicable): ____________

(iii) Name(s) of general partner(s) (include Date of Birth, Place of Birth, Social Security Number, Race and Gender):

5. If your organization is individually owned, provide the following:

(i) Date of organization: _________________________

(ii) Name of owner (include Date of Birth, Place of Birth, Social Security Number, Race and Gender):

(iii) If the form of your organization is other than that listed above, describe it and the name of the principals (include Date of Birth, Place of Birth, Social Security Number, Race and Gender):

6. LICENSING. (Attach additional pages as necessary.)

a. List jurisdiction and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable.

b. List jurisdictions in which your organizations or trade name is filed.

7. FINANCIAL DATA. (Attach additional pages as necessary.)

a. Trade References.

b. Bank References.

8. PROOF OF FINANCING.

a. Attach a financial statement, preferably audited, including your organization's latest balance sheet, cash flow statement, and income statement providing at a minimum the following items:

‐ Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes receivable, accrued income, deposits, materials inventory, and prepaid expenses);

‐ Net fixed Assets;

‐ Other Assets;

‐ Current liabilities (e.g., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries and accrued payroll taxes);

‐ Other liabilities (e.g., capital, capital stock, authorized and outstanding shares per values, earned surplus and retained earnings).

b. Name and address of firm preparing attached financial statement, and date:

c. Is the attached financial statement for the identical organization named on page one? If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent‐subsidiary).

9. SIGNATURE

18 U.S.C. 1001, False Statements Act provides:

Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willingly falsifies, conceals or covers up by any trick, scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or representation, or makes or uses any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both.

Dated _________ this ________ day of 20__

Name of Organization __________________________________

By: ___________________________________________________

Title: ________________________________________________

M_____________________________ being duly sworn deposes and says that the information herein is true and sufficiently complete so as not to be misleading.

Subscribed and sworn before me this _____________ day of 20__.

Notary Public:

My Commission Expires: