Attachment_J-2_Statement_of_Financial_Capability_Bamberg_JCC.docx
DOCX document 32 KB Posted
- Attached to
- BAMBERG JCC W/ OA CTS Federal contract opportunity
- Solicitation number
- 1630J3-18-R-00002
About this file
Financial Capability
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Text version
MODEL CENTER WRITTEN TECHNICAL RFP
ATTACHMENT J-2 – STATEMENT OF FINANCIAL CAPABILITY
BAMBERG JCC W/ OA CTS
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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