FBO_Attachment_J-2_ETA_8554.pdf

RFP NO.

U.S. DEPARTMENT OF LABOR ! Employment and Training Administration

STATEMENT OF FINANCIAL CAPABILITY

=(Insert the Name and Complete Mailing Address of Offeror)

A. DATE LAST BALANCE B. FINANCIAL CONDITION

(as of

WAS PREPARED

Date)

PERIOD COVERED (Month, Day, Year) (1) Cash . . . . . . . . . . . . . . . . . . . . . . . . . $

From To (2) Current Assets . . . . . . . . . . . . . . . . . . $

FILED WITH (3) Current Liabilities . . . . . . . . . . . . . . . . $

C. DATE FISCAL YEAR ENDS (4) Net Worth . . . . . . . . . . . . . . . . . . . . . $

(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,” a. Name of b, Amount

~ Yes ~ No ~ Yes ~ No complete< Bank (1):

(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 (2) The following advances from the Government are presently for months.

being received: (Complete columns “a” thru “e” below)

PERIOD AMOUNT

BANK

AGENCY'S NAME AND ADDRESS OF CONTRACT NO. OF

AGREEMENT WITH

CONTRACT ADVANCE

(a) (g) (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))

AMOUNT

AGENCY'S NAME, ADDRESS, AND TELEPHONE NO. CONTRACT NO. OF PERIOD OF CONTRACT

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.)

ETA 8554 (Mar 1981)