ARSR4R-HI RFI Attch 1 - Business Declaration.pdf
PDF 1 MB Posted
- Solicitation number
- A013572
About this file
This document contains a business declaration form for a federal government request for information related to replacing air route surveillance radars in Hawaii. The business declaration requests information from companies such as name, address, ownership status, gross receipts, and certifications. The related federal contract opportunity is for replacing the Air Route Surveillance Radar Version 4 systems in Hawaii with solicitation number A013572 from the Department of the Air Force Materiel Command. No other details are provided on the required products or services, response dates, or award information.
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Text version
GOVERNMENT REQUEST FOR SOURCES SOUGHT
INFORMATION
for the
AIR ROUTE SURVEILLANCE RADAR VERSION 4
REPLACEMENT - HAWAII (ARSR4R-HI)
ATTACHMENT 1 – BUSINESS DECLARIATION
7 September 2023
UNCLASSIFIED
1 Name of Firm: Tax Identification No.:
2 Address of Firm: DUNS No.: CAGE Code:
3 Telephone Number of Firm: Fax Number of Firm:
4 Name of Person Making Declaration
Telephone Number of Person Making Declaration
Position Held in the Company
Controlling Interest in Company (“X” all appropriate boxes)
Black
American
Hispanic American Native
American
Asian American
Other Minority (Specify) Other (Specify)
Female Male 8(a) Certified
(Certification letter attached)
Service Disabled Veteran Small
Business
5 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?
Yes No (If “NO,” provide the name and telephone number of the person who has this authority.)
6 Nature of Business (Specify all services/products (NAIC))
7 Years the firm has been in business:
8 No. of Employees:
9 Type of
Ownership:
Sole
Ownership
Partnership
Other (Explain)
10. Gross receipts of the firm for the last three years:
Gross Receipts
Year Ending:
Year Ending:
Year Ending:
11. Is the firm a small business? Yes
No
12. Is the firm a service-disabled veteran owned small business?
Yes
No
13. Is the firm a socially and economically disadvantaged small business?
Yes No
I DECLARE THAT THE FOREGOING STATEMENTS 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. Signature Date:
Typed Name Title:
File details come from the government source that posted it. Updated .