BlankContractorMandatorySubmissionForm.docm
DOCM document 14 KB Posted
- Attached to
- Driver Training for Minibus and Van Drivers
- Solicitation number
- BD-15-1030-0T100-0T111-00000000934
- Issued by
- Suffolk County, Massachusetts
About this file
This document is a Consultant Contractor Mandatory Submission Form related to a state and local contract opportunity in Massachusetts. The form requires bidders to disclose any additional income from the Commonwealth, individuals with a financial interest in the contract, and the key personnel assigned to the contract performance. The related state and local contract opportunity is for Driver Training for Minibus and Van Drivers.
The submission form outlines the requirements for consultant contracts within certain object classes. Bidders must complete the form and provide the requested information, which includes disclosing any additional income from the Commonwealth, individuals with a financial interest in the contract, and attaching resumes or statements of qualifications for key personnel. The form must be signed by an authorized signatory for the bidder.
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Text version
CONSULTANT CONTRACTOR MANDATORY SUBMISSION FORM
COMPLETE THE FOLLOWING ONLY FOR CONSULTANT CONTRACTS
(Within HH and NN and UU Object Classes)
Bidder: ________________________________________________________________________ RFR Name/Title: ________________________________________________________________ RFR Number: # _________________________________________________________________
Additional Income Disclosure. Pursuant to the provisions of M.G.L. c. 29, s. 29A, the following amounts represent any contracts, grants or other income due from the Commonwealth of Massachusetts, including any political subdivision or public authority, during the period of a contract. You may attach additional sheets as necessary.
|_| Please check if N/A.
Disclosure of Persons with Financial Interest (other than the bidder). Pursuant to the provisions of M.G.L. c. 29, s 29A and c. 7A, s. 6, the following individuals have a financial interest in a contract and/or with more than one percent (1%) interest in the capital stock of the contractor. You may attach additional sheets as necessary.
Key Personnel. Attach a resume or statement of qualifications for all key personnel specifically named in bidder's response to be assigned to the performance of a contract.
The information submitted herein is certified by the bidder to be accurate under the pains and penalties of perjury.
Signature of Authorized Signatory for Bidder: __________________________________________________ Title of Authorized Signatory for Bidder: _____________________________________________________ Date: __________________________________________________________
Updated 11/1/05
File details come from the government source that posted it. Updated .