Bamako LGF Contractor Info Sheet.docx

Contractor/Vendor Information Sheet

Please fill in all information below, type or print information clearly. Please complete the following questions and return to Jenel A. Charles (CharlesJA6@state.gov) by 13:00 EST, May 15, 2023.

Legal Business Name:

Tax ID No: UEID:

Mailing Address:

City, State, Zip Code:

Country:

Toll Free Number: Website Address:

Point of Contact:

Phone Number: Fax:

E-mail Address:

Country of Origin U.S. Firm ___ Foreign Vendor ___ Country: ___________

Size of Business:

Large ___ Small ___

Corporate Status:

Corporation ___ S-Corporation ___ Sole Proprietorship ___ Partnership ___ Other: _______________

Type of Ownership:

Woman ___ Veteran-owned___ (Service-disabled ____) Minority___ None of the Above ___ Other: _________________

Socio-Economic Status:

8(a) Status ___ HUBZone___ Disadvantaged____ None of the Above ___ Other:_________________

Registered in SAM: Yes____ No____

Actively registered as a small business with the Small Business Administration? Yes____ No____

DCAA-approved accounting practices? Yes____ No______________

Have you performed guard services under NAICS code 561612? Yes____ No____

Do you currently do business in Mali? Yes____ No____

Hold a Mali security license? Yes____ No____

Can you obtain a security license in Mali under your legal business name or a wholly owned subsidiary of your business? Yes____ No____