Contractor_Financial_Information.docx
DOCX document 20 KB Posted
- Attached to
- Black Creek Hiking Trail Maintenance
- Solicitation number
- AG-447U-S-14-0047
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Contractor Financial Information Sheet
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Black Creek Trail Maintenance AG-447U-S-14-0047 National Forests in Mississippi
CONTRACTOR’S FINANCIAL INFORMATION
SECTION 1 – GENERAL INFORMATION
1A.NAME
2. TYPE OF ORGANIZATION (CHECK ONE)
A. Sole Proprietorship
F. LLC
1B. STREET ADDRESS
B. General Partnership
G. Joint Venture
C. Limited Partnership
H. Non-Profit/Education
1C. CITY
| 1D. STATE |
| 1E. ZIP/POSTAL |
D. Corporation
i. Other: Specify
E. Subchapter S.
3. TAXPAYER ID NUMBER :
6. DUNS NUMBER
7. FFIS VENDER CODE: (FS VENDORS)
8. KIND OF PRODUCT OR SERVICE PROVIDED:
10. KIND OF BUSINESS- Specify one block (plus “J” if applicable)
A. LARGE BUSINESS
E. WOMAN OWNED SDB
I. INDIAN SDB
B. SMALL BUSINESS
F. VETERAN SMALL BUSINESS
J. HUB ZONE - Also
C. SMALL DISADVANTAGED BUSINESS
G. VETERAN SDB
K. Other: Please Specify
D. WOMAN OWNED SMALL BUSINESS
H. INDIAN SMALL BUSINESS
11. OWNERSHIP INFORMATION – PARTNERS – PRINCIPALS - OTHERS
| NAME |
| TITLE |
13.
14.
15.
| 16. Questions. If “Yes” to any below, provide detailed information in section vii, remarks. |
| Yes |
| No |
A. Have you/your affiliates ever filed for bankruptcy?
B. Do you have any judgments, liens, pending suits?
C. Do you have any contingent liabilities?
D. Have you/your affiliates discontinued business operations with outstanding debts
SECTION II. GOVERNMENT FINANCIAL AID AND INDEBTEDNESS
If “Yes” provide detailed information in Section VII, remarks.
| Yes |
| No |
17. Are you delinquent on any Federal Debt (OMB Circular 129)
18. Do you owe the Government for any contract or other claims?
19. Are you currently receiving Government Financing? (Bonds, Loans, Advanced Payments, Progress Payments, Other)
19a. Are you now in or pending Default on ANY Obligations (i.e. Banks, Financial Institutions, Suppliers, Other)? IF yes please provide detailed information in Section VII remarks.
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