Attachment 5 - Financial Info Sheet.pdf

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Attached to
Vegetation Management, National Forests in Mississippi
Solicitation number
12444223R0006
Issued by

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This document contains a contractor's financial information sheet for a federal solicitation seeking vegetation management services on national forests in Mississippi. The solicitation was issued by the U.S. Department of Agriculture Forest Service seeking a contractor to provide vegetation management services on various national forests located in Mississippi. The financial information sheet requires the contractor to provide details regarding its organizational structure, ownership, tax identification number, and financial status. It requests information about prior bankruptcies, judgments, contingent liabilities, discontinued business operations, and any delinquent federal debt or claims owed to the government. The purpose of this financial information sheet is to assess the contractor's financial responsibility for purposes of being awarded the vegetation management services contract.

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Other files

File Type Posted
Amendment P0001_12444223R0006.pdf PDF
Attachment 6 - Performance Relevancy Questionnaire.pdf PDF
Attachment 4 - Intent of This BPA.pdf PDF
Attachment 2 - MS Statewide 1979-0150 Rev 62.pdf PDF
Solicitation_ 12444223R0006.pdf PDF
Attachment 3 - Vicinity Map.pdf PDF
Attachment 7 - FAR Clauses That Require a Response.docx DOCX document
Attachment 1 - Schedule of Items.docx DOCX document

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Exhibit A: CONTRACTOR’S FINANCIAL INFORMATION SHEET

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 : 4. PHONE NUMBER 5. FAX NUMBER

6. DUNS NUMBER: 7. CELLPHONE NUMBER

8. KIND OF PRODUCT OR SERVICE PROVIDED: 9. EMAIL ADDRESS

10. KIND OF BUSINESS- Specify one block (plus “J” if applicable)

A. LARGE BUSINESS E. EMERGING SMALL

BUSINESS

I. INDIAN SDB

B. SMALL BUSINESS F. VETERAN SMALL BUSINESS J. HUB ZONE - Also

C. SMALL DISADVANTAGED BUSINESS G. SERVICE DISABLED

VETERAN OWNED SMALL

BUSINESS

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, attach detailed information. 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”, attach detailed information.

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 attach detailed information.

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