BUSINESS DECLARATION 10 31 24.pdf
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- Solicitation number
- 697DCK-25-R-MMKC2
About this file
This document is a Business Declaration form for a federal contract opportunity. The key details are:
The Federal Aviation Administration (FAA) is conducting a market survey to determine interest among Socially and Economically Disadvantaged Business Firm categories including Small Disadvantaged Business, 8(a), Service Disabled Veteran Owned Small Business (SDVOSB), Economically Disadvantaged Women-Owned Small Business (EDWOSB), Women Owned Small Business (WOSB), and Historically Underutilized Business Zone (HUBZone) firms for a contract to modernize stormwater drainage at the Chicago Air Route Traffic Control Center in Aurora, Illinois. The estimated project cost is over $650,000. Interested firms are required to submit a Business Declaration form, capabilities statement, and information on similar past projects by 3:00pm CDT on November 25, 2024. The acquisition strategy has not yet been determined, but may be a competitive set-aside or direct award depending on responses to the market survey.
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Other files
| File | Type | Posted |
|---|---|---|
| ZAU Storm Drainage Modernize SOW 11 18 24.pdf |
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Text version
BUSINESS DECLARATION
1. Name of Firm: Tax Identification No.:
2. Address of Firm: UEI No.:
3. Telephone Number of Firm:
4. a. Name of Person Making Declaration
b. Position Held in the Company
c. Telephone Number of Person Making Declaration
d. Email
5. Controlling Interest in Company (“X” all appropriate boxes)
a. Black American b. Hispanic American c. Native American
d. Asian American e. Other Minority (Specify) f. Other (Specify)
6. 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?
a. Yes b. No (If “NO,” provide the name and telephone number of the person who has this authority.)
7. Nature of Business (Specify all services/products (NAIC))
8. a Years the firm has been in business b. No. of Employees
9. Type of Ownership: a. Sole Ownership b. Partnership
c. Other (Explain)
10. Gross receipts for the firm for the last three years:
a.1. Year Ending: b.1. Gross Receipts $ a.3. Year Ending: b.3. Gross Receipts $ a.2. Year Ending: b.2. Gross Receipts $
11. Is the firm a Small Business? a. Yes b. No
12. Is the firm an 8a Certified Business a. Yes b. No
13. Is the firm a Service Disabled Veteran Owned Small Business? a. Yes b. No
14. Is the firm Hubzone Certified a. Yes b. No
15. Is the firm a Certified Woman-Owned Small Business? a. Yes b. No
16. Is the firm a Certified EDWOSB? a. Yes b. No
17. Is the firm a Small Disadvantaged Business? a. Yes b. 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.
Signature Date
Typed Name Title
Privacy Act Statement: Privacy Act Statement (5 U.S.C. § 552a, as amended). AUTHORITY: FAA Acquisition Management System (49 USC 40110) authorizes us to collect this information. PURPOSE(S): We will use the information provided to determine your business ownership and eligibility for contracts set-aside for certain types of businesses. ROUTINE USE(S): We may share your information among our offices involved in small business development and contracting, and may also use the information for statistical reporting.
DISCLOSURE: Providing the requested information is voluntary; however failure to furnish the information may result in ineligibility to participate in set-aside contracting.
File details come from the government source that posted it. Updated .