FAA Business Declaration Form.doc
DOC document 68 KB Posted
- Solicitation number
- 693KA9-VHF-FM-001
About this file
This is a FAA Business Declaration Form template used to collect information about firms bidding on federal contract opportunities. The form requests company identification details including the firm name, Tax Identification Number, address, and contact information for the primary point of contact responsible for the declaration.
The form requires disclosure of the company's ownership structure, including designation of controlling interest across multiple categories such as minority-owned (Black American, Hispanic American, Native American, Asian American, or other minority), female-owned, male-owned, 8(a) certified, or Service Disabled Veteran Small Business status. Additional business information requested includes the nature of business by NAICS code, years in operation, number of employees, type of ownership (sole proprietorship, partnership, or other), and gross receipts for the three preceding years. The form also contains yes/no declarations regarding small business status, service-disabled veteran ownership, and socially and economically disadvantaged business status. The declarant must certify that all statements are true and correct under penalty of criminal prosecution under 18 U.S.C. § 1001. This is a template document (OMB Control No. 2120-0595, FAA Template No. 61, rev. 08/08) and does not address specific contract requirements, deliverables, or solicitation details.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| VHF-FM Appendix A.xlsx | XLSX spreadsheet | |
| VHF-FM Market Survey.docx | DOCX document | |
| VHF-FM SOW.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
BUSINESS DECLARATION
| 1 |
| Name of Firm: |
| Tax Identification No.: |
| 2 |
| Address of Firm: |
| 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) |
FORMCHECKBOX
a. Black American
FORMCHECKBOX
b. Hispanic American
FORMCHECKBOX
c. Native American
FORMCHECKBOX
d. Asian American
FORMCHECKBOX
e. Other Minority (Specify)
| FORMCHECKBOX |
f. Other (Specify)
FORMCHECKBOX
g. Female
FORMCHECKBOX
h. Male
FORMCHECKBOX
i. 8(a) Certified (Certification letter attached) FORMCHECKBOX
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? |
FORMCHECKBOX
a. Yes
FORMCHECKBOX
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: |
| FORMCHECKBOX |
a. Sole Ownership
FORMCHECKBOX
b. Partnership
FORMCHECKBOX
c. Other (Explain)
| 10. |
| 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 |
| 11. |
| Is the firm a small business? |
FORMCHECKBOX
a. Yes
FORMCHECKBOX
b. No
| 12. |
| Is the firm a service disabled veteran owned small business? FORMCHECKBOX |
a. Yes
FORMCHECKBOX
b. No
| 13. |
| Is the firm a socially and economically disadvantaged small business? FORMCHECKBOX |
a. Yes
FORMCHECKBOX
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: |
OMB Control No. 2120-0595 FAA Template No. 61 (rev. 08/08)
File details come from the government source that posted it. Updated .