Attachment S-6 BusinessDeclarationForm.pdf

610 KB Posted

Attached to
System of Airports Reporting (SOAR) / Request for Proposal (RFP)_Amendment 4
Solicitation number
693KA9-22-R-00016
Issued by

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This document is a business declaration form required for Federal Aviation Administration contract 693KA9-22-R-00016. The form collects information on the bidding firm's ownership structure, gross receipts, and socioeconomic status. Eligible firms must be small businesses, and preference will be given to service-disabled veteran-owned small businesses and socially and economically disadvantaged small businesses. The contracting opportunity is for the System of Airports Reporting program, with the solicitation number provided.

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Other files

File Type Posted
SIR_693KA9-22-R-00016_Section B thru M_FinalRev_Amend 3.pdf PDF
Attachment S-3_Question and Comments - Government Response.pdf PDF
693KA9-22-R-00016 Section B Workbook.xlsx XLSX spreadsheet
SIR_693KA9-22-R-00016_Section B thru M_FinalRev.pdf PDF
693KA9-22-R-00016 Section B Workbook.xlsx XLSX spreadsheet
SIR_693KA9-22-R-00016_Section B thru M_Final.pdf PDF
Attachment S-8 Industry QandC.xlsx XLSX spreadsheet
Attachment S-2 Example Quality Assurance Surveillance Plan.xlsx XLSX spreadsheet
Attachment S-1 Section C - SOAR Statement of Objectives.pdf PDF
Attachment S-5_ PP Questionairre.docx DOCX document
Attachment S-7 SOO Artifacts Workbook.xlsx XLSX spreadsheet
Attachment S-3_Question and Comments Form.doc DOC document
Section A_SolOfferAwardSF33.pdf PDF
Attachment S-4 CLIENT AUTHORIZATION LETTER.docx DOCX document
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OMB Control No. 2120-0595 FAA Template No. 61 (rev. 10/08)

BUSINESS DECLARATION

1 Name of Firm:

Tax Identification No.:

2 Address of Firm:

DUNS No.:

3 a. Telephone Number of Firm: b. Fax Number of Firm:

4 a. Name of Person Making Declaration

b. Telephone Number of Person Making Declaration

c. Position Held in the Company

5 Controlling Interest in Company (“X” all appropriate boxes)

a. Black American b. Hispanic American c. Native American d. Asian American

e. Other Minority (Specify) f. Other (Specify)

g. Female h. Male i. 8(a) Certified (Certification letter attached) j. Service Disabled Veteran Small Business

6 Is the person identified in Number 4 above, responsible for day-to-day management and policy decision making, including but not limited to financial and management decisions?

a. Yes b. No (If “NO,” provide the name and telephone number of the person who has this authority.)

7 Nature of Business (Specify all services/products (NAIC))

8 (a) Years the firm has been in business (b) No. of Employees

9 Type of Ownership: a. Sole Ownership b. Partnership

c. Other (Explain)

Gross receipts of the firm for the last three years:

a.1. Year

Ending:

b.1. Gross

Receipts a.2. Year Ending:

b.2. Gross Receipts a.3. Year Ending:

b.3. Gross Receipts

Is the firm a small business? a. Yes b. No

Is the firm a service disabled veteran owned small business? a. Yes b. No

Is the firm a socially and economically disadvantaged small business? a. Yes b. No

I DECLARE THAT THE FOREGOING STATEMENTS CONCERNING

ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF. I AM

AWARE THAT I AM SUBJECT TO CRIMINAL PROSECUTION UNDER THE PROVISIONS OF 18 USCS 1001.

14. a.

Signature

b. Date:

c. Typed Name

d. Title:

Attachment S-6 693KA9-22-R-00016

File details come from the government source that posted it. Updated .