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Table Of Contents
Section Description Page Number Standard Form Standard Form 1 Volume 4 - Other Attachments Volume 4 - Other Attachments 10
CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION OMB Control Number: 3090-0007 Expiration Date: 9/30/2018
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0007. We estimate that it will take 2.5 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.
SECTION I - GENERAL INFORMATION
1A. NAME
1B. STREET ADDRESS
1C. CITY 1D. STATE 1E. ZIP CODE
2. TYPE OF ORGANIZATION (Check one)
A. SOLE PROPRIETORSHIP
B. GENERAL PARTNERSHIP
C. LIMITED PARTNERSHIP
D. CORPORATION
E. SUBCHAPTER S CORPORATION
I. OTHER (Specify below)
3. TAXPAYER ID NUMBER 4. DATE ORGANIZATION ESTABLISHED 5. STATE OF INCORPORATION
6. TRADE STYLE NAME (Provide a copy of filing) 7. KIND OF PRODUCT OR SERVICE PROVIDED
8. FORMER BUSINESS NAME
D. RETAILER
E. OTHER (Specify) B. FIFO
A. LIFO C. AVERAGE COST
D. OTHER (Specify)
11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS
NAME
10. INVENTORY VALUATION METHOD
9. KIND OF BUSINESS
A. MANUFACTURER
B. CONTRACTOR
C. WHOLESALER
TITLE
(If partner, state G(General) or L(Limited) in column)
ACTUAL TITLE G OR L
PERCENT
BUSINESS OWNED
12. PARENT COMPANY (If applicable)
13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED
INFORMATION IN SECTION VIII, REMARKS YES NO
A. NAME
B. CITY C. STATE
A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY?
B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS?
C. DO YOU HAVE ANY CONTINGENT LIABILITIES?
D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCONTINUED BUSINESS OPERATIONS WITH
OUTSTANDING DEBTS?
SECTION II - GOVERNMENT FINANCIAL AID AND INDEBTEDNESS
14A. ARE YOU DELINQUENT ON ANY FEDERAL DEBT (OMB CIRCULAR A-129)
(If "Yes", provide detailed information, Section VIII, Remarks)
14B. DO YOU OWE THE
GOVERNMENT
FOR ANY
CONTRACT OR
OTHER CLAIMS?
YES NO
IF "YES", COMPLETE THE ITEMS BELOW
AGENCY CLAIM AMOUNT PAYMENT MATURITY BALANCE
15A. AGENCY INVOLVED WITH DELINQUENCY 15B. AMOUNT OF DELINQUENCY ($)
16. ARE YOU
CURRENTLY
RECEIVING
GOVERNMENT
FINANCING?
YES NO
YES
NO (Go to Section III )
17. COMPLETE ITEMS BELOW IF APPLICABLE
A. INDUSTRIAL REVENUE BONDS
B. GUARANTEED LOANS
C. ADVANCED PAYMENTS
D. PROGRESS PAYMENTS
AUTHORIZED ($) IN USE ($) GOVERNMENT AGENCY INVOLVED
E. OTHER (Specify)
GENERAL SERVICES ADMINISTRATION GSA 527 (REV. 10/2015)
F. LIMITED LIABILITY COMPANY
G. JOINT VENTURE
H. TRUST
TYPE OF FINANCING
Standard Form Page 1
GSA 527 (REV. 10/2015) PAGE 2
SECTION III - FINANCIAL STATEMENTS
Prepared Financial Statements with notes may be provided in lieu of completing Section III
When financial statements are prepared or certified by independent accountants and transcribed to this form, please furnish the name and address of accountant of accounting firm.
18. ARE YOU THE INCUMBENT CONTRACTOR FOR THIS SOLICITATION?
NO
19A. NAME
19B. STREET ADDRESS
19C. CITY 19D. STATE 19E. ZIP CODE
20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S,
PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE
LISTED FIGURES ARE:
ACTUAL
IN THOUSANDS
IN MILLIONS
U.S. DOLLARS
FOREIGN CURRENCY (Specify)
21. BALANCE SHEET AS OF (Month, Day, Year) 22. FISCAL YEAR ENDS (Month, Day, Year) 23. PREPARED STATEMENTS
YES
ARE ATTACHED
24. ASSETS 25. LIABILITIES AND NET WORTH
A. Current Assets A. Current Liabilities
Cash Short Term cash investments Accounts receivable, less allowance for doubtful accounts of $ Inventories Other current assets (Itemize below)
Total Current Assets
B. Property, Plant and Equipment
Accounts payable Notes payable (current) Current portion of long term debt Accrued expenses Accrued taxes on income/excess profits Other current liabilities (Itemize below)
Total Current Liabilities
B. Other Liabilities
Land Buildings and equipment Leasehold improvements Less accumulated depreciation and amortization
Total Property, Plant and Equipment C. Other Assets
Investments in and advance to affiliated company Goodwill, less amortization Due from officer, employee Other (Itemize below)
Total Other Assets
D. TOTAL ASSETS
Mortgages Bonds Deferred income taxes Other long term debt
Total Other Liabilities
Total Liabilities
C. Minority Interest in Subsidiary D. Net Worth
Preferred stock Common stock Additional paid-in capital Retained earnings/owner's equity Less, Treasury stock
Total Net Worth
E. TOTAL LIABILITIES AND NET WORTH
SECTION IV - INCOME STATEMENT
26. FROM (Month, Day, Year) 27. TO (Month, Day, Year)
A. Net Sales
28. INCOME
Cost and Expenses Cost of Goods Sold Depreciation and Amortization
Selling, General, and Admin. Expenses Interest Expense Other Expenses (Itemize below)
Minority Interest in Earnings of Subsidiaries
Total Costs and Expenses
Earnings Before Taxes Taxes on Income Income Before Extraordinary Items Extraordinary Gains (Losses) Net of Taxes
NET INCOME (LOSS)
Standard Form Page 2
ZIP CODE
Yes No
Yes No
A.
B.
C.
CITY STATE ZIP CODE
Yes No
Yes No
AREA CODE NUMBER
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
37. Maximum Amount Authorized ($)
38. Amount Outstanding ($)
39. Loans Secured by Company's Assets - Real and Personal Property
BANK 1 BANK 2
SECTION V - BANKING AND FINANCE COMPANY INFORMATION
(Please attach a separate sheet using this format for any additional banks.)
ITEM
29. Name of Bank
30. Contact Person
31. Phone Number
32. Fax Number
33. Address
34. Amount Owing ($)
35. Term Loans
36. Line of Credit
D.
SECURED PARTY NAME CONTACT NAME
STREET ADDRESS CITY STATE ZIP CODE
SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)
SECURED PARTY NAME CONTACT NAME
STREET ADDRESS CITY STATE ZIP CODE
SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)
SECURED PARTY NAME CONTACT NAME
STREET ADDRESS CITY STATE ZIP CODE
SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)
SECURED PARTY NAME CONTACT NAME
STREET ADDRESS CITY STATE ZIP CODE
SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)
40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET
PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE?
41B. TOTAL
LIABILITY ($)
41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP,
ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR
FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES
INCLUDED ON THE BALANCE SHEET?
YES NO
42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER?
NO YES (Explain in Section VII, Remarks)
NO YES (Provide detailed information in Section VII, Remarks)
GSA 527 (REV. 10/2015) PAGE 3
AREA CODE NUMBER EXTENSION
STREET ADDRESS
CITY STATE
Standard Form Page 3
SECTION VI - PRINCIPAL MERCHANDISE OR RAW MATERIAL SUPPLIER INFORMATION
(Please attach separate sheet(s) using this format for additional suppliers.)
43. PAST DUE ACCOUNTS PAYABLE ($)
ITEM 44. SUPPLIER 1 45. SUPPLIER 2
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
STATECITY ZIP CODE
ITEM 46. SUPPLIER 3 47. SUPPLIER 4
A. Name of Supplier B. Contact Person
C. Telephone
D. Fax
E. Address
F. Amount Now Owing ($) G. High Credit ($)
A. Name of Supplier B. Contact Person
C. Telephone
D. Fax
E. Address
F. Amount Now Owing ($) G. High Credit ($)
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
SECTION VII - CONSTRUCTION/SERVICE CONTRACTS INFORMATION (Public Buildings Service Contracts Only)
CONTRACTS IN FORCE
STREET ADDRESS
CITY STATE ZIP CODE
GSA 527 (REV. 10/2015) PAGE 4
ITEM 48. CONTRACT 1 49. CONTRACT 2
A. Location B. Owner's Name
C. Address
D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
STREET ADDRESS
CITY STATE ZIP CODE
STREET ADDRESS
CITY STATE ZIP CODE
ITEM
A. Location B. Owner's Name
C. Address
D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
50. CONTRACT 3 51. CONTRACT 4
STREET ADDRESS
CITY STATE ZIP CODECITY STATE ZIP CODE
STREET ADDRESS
Standard Form Page 4
GSA 527 (REV. 10/2015) PAGE 5
C. Address
D. Telephone
E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
ITEM 58. JOB 3 59. JOB 4
A. Location B. Contact's Name
C. Address
D. Telephone
E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
ITEM 60. JOB 5 61. JOB 6
A. Location B. Contact's Name
C. Address
D. Telephone
E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
ITEM 52. CONTRACT 5 53. CONTRACT 6
A. Location B. Owner's Name
C. Address
D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
STREET ADDRESS
CITY STATE ZIP CODE
STREET ADDRESS
CITY STATE ZIP CODE
ITEM
A. Location B. Owner's Name
C. Address
D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
54. CONTRACT 7 55. CONTRACT 8
STREET ADDRESS
CITY STATE ZIP CODE
STREET ADDRESS
CITY STATE ZIP CODE
LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS
ITEM 56. JOB 1 57. JOB 2
A. Location B. Contact's Name
Standard Form Page 5
CERTIFICATION
For the purpose of establishing financial responsibility with, or procuring credit from the General Services Administration, we furnish the above as a true and correct statement of our financial condition and further certify that all other statements are true and correct. There has been no material change in the applicant's financial condition since the date of the above statement. We agree to notify you immediately in writing of any materially unfavorable change in our financial condition. In the absence of such notice or of a new and full financial statement, this is to be considered as a continuing statement.
NAME OF BUSINESS BY (Signature of Authorized Official)
NAME OF AUTHORIZED OFFICIAL (Type or print)
TITLE OF AUTHORIZED OFFICIAL (Type or print)
DATE
GSA 527 (REV. 10/2015) PAGE 6
NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
64. PRESENT AMOUNT OF BONDING
COVERAGE ($)
65. HAS YOUR APPLICATION FOR SURETY
BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in
Remarks)
66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A
FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR
SUPPLIERS? (If Yes, please provide detailed information in Remarks)
YES NO YES NO
SECTION VIII - REMARKS
REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).)
LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS
ITEM 62. SURETY COMPANY 1 63. SURETY COMPANY 2
A. Company Name B. Contact's Name
C. Telephone
D. Fax
E. Address
AREA CODE NUMBER EXTENSION
AREA CODE
Standard Form Page 6
(See ).
SOLICITATION, OFFER,
AND AWARD
(Construction, Alteration, or Repair) IMPORTANT - The "offer" section on the reverse must be fully completed by offeror.
9. FOR INFORMATION
CALL:
NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid and "bidder".
SOLICITATION
1. SOLICITATION NUMBER
5. REQUISITION/PURCHASE REQUEST NUMBER
CODE
6. PROJECT NUMBER
8. ADDRESS OFFER TO
4. CONTRACT NUMBER
7. ISSUED BY
10. THE GOVERNMENT REQUIRES PERFORMANCE OF THE WORK DESCRIBED IN THESE DOCUMENTS (Title, identifying number, date)
11. The contractor shall begin performance within
12a. THE CONTRACTOR MUST FURNISH ANY REQUIRED PERFORMANCE AND PAYMENT BONDS?
(If "YES", indicate within how many calendar days after award in Item 12b.)
13. ADDITIONAL SOLICITATION REQUIREMENTS:
a. Sealed offers in original and
b. An offer guarantee
c. All offers are subject to the (1) work requirements, and (2) other provisions and clauses incorporated in the solicitation in full text or by reference.
d. Offers providing less than
STANDARD FORM 1442 (REV. 8/2014)
Prescribed by GSA - FAR (48 CFR) 53.236-1(d) calendar days for Government acceptance after the date offers are due will not be considered and will be rejected.
is, is not required.
local time containing offers shall be marked to show the offeror's name and address, the solicitation number, and the date and time offers are due.
(date). If this is a sealed bid solicitation, offers will be publicly opened at that time. Sealed envelopes copies to perform the work required are due at the place specified in Item 8 by (hour) award, YES NO notice to proceed. This performance period is mandatory negotiable.
calendar days and complete it within calendar days after receiving
a. NAME b. TELEPHONE NUMBER (Include area code) (NO COLLECT CALLS)
12b. CALENDAR DAYS
2. TYPE OF SOLICITATION
SEALED BID (IFB)
NEGOTIATED (RFP)
3. DATE ISSUED PAGE OF PAGES
Standard Form Page 7
17. The offeror agrees to perform the work required at the prices specified below in strict accordance with the terms of this solicitation, if this offer is accepted calendar days after the date offers are due. (Insert any number equal to or greater than the minimum requirement by the Government in writing within stated in Item 13d. Failure to insert any number means the offeror accepts the minimum in Item 13d.)
OFFER (Must be fully completed by offeror)
AMOUNTS
18. The offeror agrees to furnish any required performance and payment bonds.
19. ACKNOWLEDGMENT OF AMENDMENTS
(The offeror acknowledges receipt of amendments to the solicitation -- give number and date of each)
AMENDMENT
NUMBER
DATE.
AWARD (To be completed by Government)
CONTRACTING OFFICER WILL COMPLETE ITEM 28 OR 29 AS APPLICABLE
14. NAME AND ADDRESS OF OFFEROR (Include ZIP Code)
CODE FACILITY CODE
15. TELEPHONE NUMBER (Include area code)
16. REMITTANCE ADDRESS (Include only if different than Item 14.)
20a. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER (Type or print)
21. ITEMS ACCEPTED:
22. AMOUNT
26. ADMINISTERED BY
30a. NAME AND TITLE OF CONTRACTOR OR PERSON AUTHORIZED TO SIGN (Type or print)
31c. DATE
STANDARD FORM 1442 (REV. 8/2014) BACK
31b. UNITED STATES OF AMERICA
BY
31a. NAME OF CONTRACTING OFFICER (Type or print)
29. AWARD (Contractor is not required to sign this document.) Your offer on this solicitation is hereby accepted as to the items listed. This award consummates the contract, which consists of (a) the Government solicitation and your offer, and (b) this contract award. No further contractual document is necessary.
30b. SIGNATURE 30c. DATE
28. NEGOTIATED AGREEMENT (Contractor is required to sign this document and return and deliver all items or perform all work requirements identified on this form and any continuation sheets for the consideration stated in this contract. The rights and obligations of the parties to this contract shall be governed by (a) this contract award, (b) the solicitation, and (c) the clauses, representations, certifications, and specifications incorporated by reference in or attached to this contract.
copies to issuing office.) Contractor agrees to furnish
24. SUBMIT INVOICES TO ADDRESS SHOWN IN
(4 copies unless otherwise specified)
23. ACCOUNTING AND APPROPRIATION DATA
ITEM 25. OTHER THAN FULL AND OPEN COMPETITION PURSUANT TO
27. PAYMENT WILL BE MADE BY
10 U.S.C. 2304(c) ( ) 41 U.S.C. 3304(a) ( )
20b. SIGNATURE 20c. OFFER DATE
Standard Form Page 8
PAGE
GENERAL SERVICES ADMINISTRATION
OF
ITEM NO., FORM OR
STOCK NUMBER DESCRIPTION OF ARTICLES OR SERVICES QUAN-
TITY
UNIT
OF
ISSUE
UNIT
PRICE
AMOUNT
0001 __________
Upgrade security systems in FHWA
Upgrade finishes in FHWA suite
SECURITY
FINISHES
__________ __________STFB - FHWA SUITE ALTERATIONS
STFB - FHWA SUITE ALTERATIONS
LS
PoP: 04/15/2019 - 04/22/2020
LS
PoP: 04/15/2019 - 04/22/2019 area of STFB in STFB
Standard Form Page 9
47PE0619Q0009 - Volume 4 - Other Attachments - List of Attachments Documents Table of Contents
Attachmen t Number
Document Title ECF
SF24 - Bid Bond STFB - FHWA SUITE
ALTERATIONS 3122019
10 - Solicitation and Amendments
C301-SAT STFB - FHWA SUITE
ALTERATIONS 3122019
10 - Solicitation and Amendments
NEW FLOOR LAYOUT DRAWINGS STFB -
FHWA SUITE ALTERATIONS 3122019
2 - Technical Documents
Waste_Mgmt_Plan STFB - FHWA SUITE
ALTERATIONS 3122019
2 - Technical Documents
Wage Determination STFB - FHWA SUITE
ALTERATIONS 3122019
10 - Solicitation and Amendments
SECURITY LOCATIONS DRAWINGS STFB -
FHWA SUITE ALTERATIONS 3122019
2 - Technical Documents
Security Systems Standard SOW STFB - FHWA
SUITE ALTERATIONS 3122019
2 - Technical Documents
SOW STFB - FHWA SUITE ALTERATIONS
3122019
10 - Solicitation and Amendments
Bid Pricing Breakdown Sheet STFB - FHWA
SUITE ALTERATIONS 3122019
10 - Solicitation and Amendments
Solicitation STFB - FHWA SUITE
ALTERATIONS 3122019
10 - Solicitation and Amendments
Agreement STFB - FHWA SUITE
ALTERATIONS 3122019
10 - Solicitation and Amendments
12 SOW STFB FHWA Suite Alterations 3122019 2 - Technical Documents
Volume 4 - Other Attachments Page 10
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| ProjectNo[0]: 17-039 / RWA# N1607965 |
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| IssuedBy[0]: Carolinas Branch AMD |
77 Forsyth Street SW Atlanta, GA 30303-3490
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| Name9a[0]: Jerrime Hughes |
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Carolinas Branch AMD 77 Forsyth Street SW Atlanta, GA 30303-3490
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| WorkDescribed[0]: FHWA Security Systems Standard SOW |
STFB FHWA Security Stems STFB FWHA New Floor Layout STFB FHWA Suite Alterations SOW Rev 3 Agreement STFB FHWA Suite Alterations 3122019 Solicitation STFB FHWA Suite Alterations 3122019 C301 Sat STFB FHWA Suite Alterations 3122019 Wage Determination STFB FHWA Suite Alterations 3122019
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