Business Declaration_building construction.pdf
PDF 225 KB Posted
- Solicitation number
- 697DCK-25-R-00227
About this file
The Business Declaration is a standard form used to collect key information about a business seeking to participate in a federal contract opportunity. The document reveals the business is in building construction (NAICS 236220) with a $45.0 million size standard, and includes sections for identifying business ownership characteristics, company size, and potential small business classifications. The form allows businesses to declare their status across multiple categories, including minority-owned, woman-owned, service-disabled veteran-owned, and socially/economically disadvantaged small business designations. The form is part of a market survey for a Design-Build project for a new Air Traffic Control Tower (ATCT) in Hillsboro, Oregon, being conducted by the Federal Aviation Administration's Southwestern Region.
The form requires detailed business information such as years in operation, number of employees, type of ownership, and gross receipts, with a declaration that all provided information is true and subject to potential criminal prosecution under 18 USCS 1001 if falsified. The Privacy Act Statement indicates the information will be used to determine business ownership and eligibility for set-aside contracts, with voluntary disclosure that may impact contracting participation. The form is dated October 2013 and is specifically designed for businesses interested in federal contracting opportunities, particularly those with small business or disadvantaged business enterprise designations.
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Other files
| File | Type | Posted |
|---|---|---|
| HIO_SOW.pdf | ||
| market survey_HIO_3-31-25.pdf |
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Text version
Business Declaration (10/2013) Page 1 of 2
BUSINESS DECLARATION
1 Name of Firm:
Tax Identification No.:
2 Address of Firm: UEI No.:
3 a. Telephone Number of Firm: b. Fax Number of Firm:
4 a. Name of Person Making Declaration
b. Telephone Number of Person Making Declaration
c. Position Held in the Company
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)
g. Female h. Male i. 8(a) Certified (Certification letter attached) j. Service Disabled Veteran Small Business
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 Specify North American Industry Classification (NAIC) d
BUILDING CONSTRUCTION 236220 $45.0 MIL
8 Nature of Business (Specify all services/products
9 (a) Years the firm has been in business (b) No. of Employees
10 Type of Ownership: a. Sole Ownership b. Partnership
c. Other (Explain)
11. Gross receipts of the firm for the last three years:
a.1. Year
Ending:
b.1. Gross
Receipts a.2. Year
Ending:
b.2. Gross
Receipts a.3. Year
Ending:
b.3. Gross
Receipts
12. Is the firm a small business? a. Yes b. No
13. Is the firm a service disabled veteran owned small business? a. Yes b. No
14. Is the firm a socially and economically disadvantaged small business? a. Yes b. No
15 Is the firm a woman-owned small business? a. Yes b. No
Business Declaration (10/2013) Page 2 of 2
I DECLARE THAT THE FOREGOING STATEMENTS CONCERNING
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.
16 a.
Signature
b. Date:
c. Typed Name
d. 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.
| (b) No. of Employees |
| (a) Years the firm has been in business |
| b. Partnership |
| a. Sole Ownership |
| Type of Ownership: |
| c. Other (Explain) |
| b.1. Gross Receipts |
| a.1. Year Ending: |
| Gross receipts of the firm for the last three years: |
| b.3. Gross Receipts |
| a.3. Year Ending: |
| b.2. Gross Receipts |
| a.2. Year Ending: |
| 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. |
| b. Date: |
| 16 a. Signature |
| d. Title: |
| c. Typed Name |
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