BUSINESS DECLARATION.docx

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Sources Sought for multiple projects located at Air Route Traffic Control Center in Minneapolis, MN
Solicitation number
697DCK-25-M-JHKC1
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The Business Declaration is a standard form documenting key business details for a potential federal contract opportunity with the Federal Aviation Administration (FAA). The document captures comprehensive company information including business ownership characteristics, company size, certifications, and financial history. Notable details include sections for minority ownership status, business type (e.g., small business, 8a, service-disabled veteran-owned, HUBZone, woman-owned), years in business, number of employees, and three-year gross receipts.

The related federal contract opportunity is a Sources Sought market survey for multiple construction projects at the Minneapolis Air Route Traffic Control Center. The FAA is seeking contractors for projects ranging from $50,000 to $500,000, with scopes including general construction, electrical, and mechanical work. Specific projects include replacing chilled water valves, removing/replacing floor epoxy, exterior doors, gas heaters, humidifiers, lighting systems, power panels, and boiler vent stacks. Small businesses are strongly encouraged to respond, and interested firms must have an active SAM.gov registration. Submissions are due by 3:00pm CDT on June 02, 2025, and must include a Business Declaration form, capability statement, and project interest details.

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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 fo 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

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 .