J-2 (Statement of Financial Capability).docx
DOCX document 27 KB Posted
- Attached to
- Operation of the Los Angeles Job Corps Center
- Solicitation number
- 1605JW-23-R-00009
About this file
This document is a template for a Statement of Financial Capability required as an attachment to responses for solicitation number 1605JW-23-R-00009 from the Department of Labor Employment and Training Administration. The template requires offerors to provide financial information including cash on hand, current assets and liabilities, net worth, fiscal year end date, sources of financing, details of any advance payments requested, and a list of current government contracts. It must be certified by a signature of the offeror's authorized representative. The solicitation is for the operation of the Los Angeles Job Corps Center to provide career technical training and academic programs to at-risk youth and young adults.
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Text version
MODEL CENTER WRITTEN TECHNICAL RFP
ATTACHMENT J-2 – STATEMENT OF FINANCIAL CAPABILITY
U.S. DEPARTMENT OF LABOR * Employment and Training Administration
RFP NO.
STATEMENT OF FINANCIAL CAPABILITY
(Insert the Name and Complete
Mailing Address of Offeror)
A. DATE LAST BALANCE
WAS PREPARED
B. FINANCIAL CONDITION
(As of Date) _______________ 19____
(1) Cash .........................................................$___________________
(2) Current Assets .........................................$___________________
(3) Current Liabilities .....................................$___________________
(4) Net Worth ................................................$___________________
PERIOD COVERED (Month, Day, Year)
From
To
C. DATE FISCAL YEAR ENDS
(Month, Day, Year)
D. FINANCIAL ARRANGEMENTS TO FACILITATE PERFORMANCE DURING INITIAL PHASE OF CONTRACT ("X" appropriate box(es))
(1) Own Resources
(2) Bank credit
If "YES" complete
a. Name of Bank(s):
b. Amount
| |_| |
| Yes |
| |_| |
| No |
| |_| |
| Yes |
| |_| |
| No |
(3) Other (If "YES", specify)
| |_| |
| Yes |
No
E. IF ADVANCE PAYMENT IS INDICATED UNDER D(3) ABOVE, COMPLETE THE FOLLOWING:-
(1) Estimated Amount of Advance Payment
$_______________________ for ___________ months.
(2) The following advances from the Government are presently being received: (Complete Columns "a" thru "e" below)
AGENCY'S NAME AND ADDRESS
PERIOD
OF
CONTRACT
CONTRACT NO.
AMOUNT
OF
ADVANCE
BANK
AGREEMENT WITH
| (a) |
| (b) |
| (c) |
| (d) |
| (e) |
ETA 8554 (Mar. 1981)
F. THE FOLLOWING IS A LIST OF CURRENT CONTRACTS WITH THIS OR ANY OTHER GOVERNMENT AGENCIES.
(If additional space is needed, attach additional sheet(s))
AGENCY'S NAME, ADDRESS, AND TELEPHONE NO.
CONTRACT NO.
AMOUNT
OF
CONTRACT
PERIOD OF CONTRACT
| (1) |
| (2) |
| (3) |
| (4) |
G. IF OVERHEAD/INDIRECT COSTS ARE INCLUDED IN YOUR COST PROPOSAL, THE FOLLOWING DATA WILL BE FURNISHED.
(1) Name and Address(es) of Cognizant Government Audit Agency
(2) Name and Address of Government Auditor
Telephone Area Code No. ( )
(3) Date Last Rate was Computed (Month, Day, Year) and Negotiated ─────────────────────────────────
(4) If no government audit agency computed and authorized the rate claimed, complete (a), (b), and (c) below.
(a) How it is computed?
(b) Who?
(c) Date (Mo., Day, Yr.)
ATTACH COMPUTATION DATA USED.
COMMENTS
CERTIFICATION:
I CERTIFY that to the best of my knowledge and belief the information contained herein is TRUE and CORRECT.
SIGNATURE
TYPED NAME AND TITLE
DATE (Mo., Day, Yr.)
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