Beartooth_(5)_Appendix_B.doc

DOC document 215 KB Posted Feb 28, 2013

Attached to: CUSTER NATIONAL FOREST Beartooth RD Prospectus Educational Guiding Services Federal contract opportunity
Solicitation number: AG-0355-S-13-0007
Issued by: Department of Agriculture Forest Service R1-Northern Region

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Appendix B

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Other files attached to CUSTER NATIONAL FOREST Beartooth RD Prospectus Educational Guiding Services, newest first.
File	Type	Posted
APPENDIX_D_-_AnOpPlan_Corrected_020613.doc	DOC document	Mar 6, 2013
Beartooth_2013_PROSPECTUS.doc	DOC document	Feb 28, 2013
Beartooth_(6)_Appendix_C.doc	DOC document	Feb 28, 2013
Beartooth_Apendiix_E.docx	DOCX document	Feb 28, 2013
Beartooth_(4)_Appendix_A.rtf	RTF text file	Feb 28, 2013
Beartooth_Appendix_D.docx	DOCX document	Feb 28, 2013

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USDA Forest Service FS-6500-24 (v.05/09) Exp. (10/31/2012) - Page 1

FINANCIAL STATEMENT

(Ref. 36 CFR 223.7(e), 36 CFR 251.54(e)(2), Federal Acquisition Regulation 48 CFR 9.104-1.)

INSTRUCTIONS: Forest Service (FS) requires the respondent to provide the most recent fiscal year financial statement. FS may also request the respondent to provide two additional years of financial data, on a case by case basis. If more space is needed to fully answer any item below, attach additional sheets.

1. NAME OF CORPORATION, PARTNERSHIP, OR PROPRIETORSHIP (include any names the organization/firm operated under during past three years and specify the year operated for each name):

2. STATE INCORPORATED

3. DATE INCORPORATED

4. ADDRESS OF PRINCIPAL PLACE OF BUSINESS (with ZIP CODE)

5. IF PARTNERSHIP, NAMES OR PARTNERS, AND THEIR PARTNERSHIP INTERESTS

6. NAMES, TITLES, AND ADDRESSES OF CORPORATE OFFICERS AND DIRECTORS, WITH NUMBER OF SHARES OF STOCK OWNED BY EACH

FULL NAME

TITLE

ADDRESS

(Number, Street, City, State, and ZIP CODE)

SHARES OWNED

FORMDROPDOWN

7. REFERENCES (At least three should be given, preferable banks):

Full Name

ADDRESS

(Number, Street, City, State, and ZIP CODE)

NOTE: Respondents may submit certified financial statements in lieu of answering PARTS A through C on the next pages. However, respondents must complete either certification statement PART D (1) or PART D (2) at the bottom of the last page.

PART A. BALANCE SHEET

CURRENT YEAR PAST YEAR THIRD YEAR

(MO/DA/YR) (MO/DA/YR) (MO/DA/YR)

YEAR ENDED

ASSETS

CURRENT ASSETS:

CASH

RECEIVABLES-TRADE

LESS ALLOWANCES FOR DOUBTFUL ACCOUNTS

< >

< FORMDROPDOWN

INVENTORIES (LIST MAJOR CATEGORIES):

FORMTEXT

SUPPLIES AND MISCELLANEOUS

FORMTEXT

MARKETABLE SECURITIES

FORMTEXT

PREPAID EXPENSES

SUPPLIES INVENTORY

FORMDROPDOWN

OTHER CURRENT ASSETS:

FORMDROPDOWN

TOTAL CURRENT ASSETS

FORMDROPDOWN

FIXED ASSETS:

FORMDROPDOWN

LAND

FORMDROPDOWN

BUILDINGS

FORMDROPDOWN

MACHINERY AND EQUIPMENT

FORMDROPDOWN

PLANT

FORMDROPDOWN

LEASEHOLD IMPROVEMENTS

FORMDROPDOWN

OTHER

FORMDROPDOWN

LESS ALLOWANCE FOR DEPRECIATION

< >

< FORMDROPDOWN

BOOK VALUE-FIXED ASSETS

FORMDROPDOWN

OTHER ASSETS:

FORMDROPDOWN

DEPOSITS-CASH

FORMDROPDOWN

DEPOSITS-SECURITIES

FORMDROPDOWN

TOTAL-OTHER ASSETS

FORMDROPDOWN

TOTAL ASSETS

FORMDROPDOWN

LIABLIITIES AND OWNER EQUITY

CURRENT YEAR

PAST YEAR

THIRD YEAR

CURRENT LIABILITIES:

FORMDROPDOWN

ACCOUNTS PAYABLE-TRADE

FORMDROPDOWN

ACCRUED PAYROLL

FORMDROPDOWN

ACCRUED PAYROLL TAXES AND INSURANCE

FORMDROPDOWN

NOTES PAYABLE

FORMDROPDOWN

INCOME TAXES-CURRENT

FORMDROPDOWN

OTHER TAXES

FORMDROPDOWN

CURRENT PORTION OF LONG-TERM DEBT

FORMDROPDOWN

OTHER CURRENT LIABILITIES (SPECIFY):

FORMDROPDOWN

TOTAL CURRENT LIABILITIES

OTHER LIABILITIES:

DEFERRED INCOME TAXES

LOANS FROM OFFICERS/PARTNERS

FORMDROPDOWN

LONG-TERM OBLIGATIONS-LESS CURRENT AMOUNT

FORMDROPDOWN

TOTAL OTHER LIABILITIES

FORMDROPDOWN

TOTAL LIABILITIES

OWNER EQUITY:

CAPITAL STOCK OUTSTANDING

RETAINED EARNINGS (DEFICIT)

PARTNERS' INVESTMENT (DEFICIT)

TOTAL OWNER EQUITY

TOTAL LIABILITIES AND OWNER EQUITY

PART B. SUPPLEMENTAL DATA

THIS STATEMENT IS ON THE-CASH BASIS

FORMDROPDOWN

ACCRUAL BASIS

INVENTORIES ARE-LIFO FIFO COST OR MARKET WHICHEVER IS LOWER FORMDROPDOWN

NAMES OF CONTRACTORS OR SUB-CONTRACTORS USED (IF ANY):

PART C. INCOME STATEMENT CURRENT YEAR PAST YEAR THIRD YEAR

GROSS SALES

LESS-RETURNS AND ALLOWANCES

< >

NET SALES

LESS-COST OF GOODS SOLD

< >

GROSS PROFIT ON SALES

LESS-SELLING EXPENSE

< >

NET PROFIT (LOSS) ON SALES

GENERAL EXPENSE:

OFFICERS SALERIES

LEGAL AND OTHER PROFESSIONAL EXPENSE

OFFICE EXPENSE

TOTAL GENERAL EXPENSE

NET OPERATING PROFIT (LOSS)

ADD-OTHER INCOME

LESS-INTEREST EXPENSE

INCOME TAXES

< >

OTHER EXPENSE

< >

NET AMOUNT OF OTHER INCOME AND EXPENSE

< >

NET PROFIT (LOSS) FOR YEAR

NOTE: Offers must set forth full, accurate, and complete information as required in this Financial Statement (including any attachments). The penalty for making false statements in this Financial Statement is prescribed in 18 U.S.C. 1001.

PART D (1). CERTIFICATION FOR CORPORATIONS OR PARTNERSHIPS

We, the undersigned, general officers (or members) of (Name of corporation or partnership) being severally sworn, each declares that the above or attached financial statements are true and correct, and that it covers all of the financial affairs of said company (or) firm up to and including the date of 2 .

CERTIFYING OFFICIAL'S NAME AND TITLE

SIGNATURE (Sign in ink)

DATE

CERTIFYING OFFICIAL'S NAME AND TITLE

SIGNATURE (Sign in ink)

DATE

SWORN TO AND SUBSCRIBED before me this day of (Month/Year).

(Affix Notary Seal)

SIGNATURE

TITLE

PART D (2). CERTIFICATION FOR INDIVIDUALS

I swear (or affirm) that the above or attached financial statements are true and correct to the best of my knowledge.

INDIVIDUAL'S NAME AND TITLE

SIGNATURE (Sign in ink)

DATE

SWORN TO AND SUBSCRIBED before me this day of (Month/Year)

(Affix Notary Seal)

SIGNATURE

TITLE

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0082. The time required to complete this information collection is estimated to average 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer.

The Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information Act (5 U.S.C. 552) govern the confidentiality to be provided for information received by the Forest Service.

(U.S. GPO: 1996-720-508

File details come from the government source that posted it. Updated Nov 14, 2017.