Business Declaration form.doc
DOC document 110 KB Posted
- Attached to
- ARP HQ Strategic Planning Support
- Solicitation number
- 693KA9-450-05122026
About this file
This is a Business Declaration form used by the Federal Aviation Administration (FAA) to collect information about vendor business ownership, eligibility, and qualifications for contract participation.
The form requires vendors to provide company identification details including name, Tax Identification Number, DUNS Number, address, and contact information. Vendors must identify the controlling interest in the company by marking applicable categories including minority ownership (Black American, Hispanic American, Native American, Asian American, or other minority), gender of controlling owner (female or male), and special certifications such as 8(a) Certified status or Service Disabled Veteran Small Business designation. Additional required information includes the North American Industry Classification (NAIC) code, nature of business, years in operation, number of employees, type of ownership structure, and gross receipts for the last three years. The form requires vendors to declare whether the firm qualifies as a small business, service disabled veteran-owned small business, socially and economically disadvantaged small business, or woman-owned small business. A person authorized for day-to-day management and policy decision-making must be identified, and the declaring official must sign the form under penalty of perjury per 18 U.S.C. Section 1001. The FAA uses this information to determine business ownership and eligibility for set-aside contracting opportunities. Submission is voluntary but failure to provide the information may result in ineligibility for set-aside contracts.
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Text version
BUSINESS DECLARATION
| 1 |
| Name of Firm: |
| Tax Identification No.: |
| 2 |
| Address of Firm: |
| DUNS 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) |
FORMCHECKBOX
a. Black American
FORMCHECKBOX
b. Hispanic American
FORMCHECKBOX
c. Native American
FORMCHECKBOX
d. Asian American
FORMCHECKBOX
e. Other Minority (Specify)
| FORMCHECKBOX |
f. Other (Specify)
FORMCHECKBOX
g. Female
FORMCHECKBOX
h. Male
FORMCHECKBOX
i. 8(a) Certified (Certification letter attached) FORMCHECKBOX
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? |
FORMCHECKBOX
a. Yes
FORMCHECKBOX
b. No (If “NO,” provide the name and telephone number of the person who has this authority.)
| 7 |
| Specify North American Industry Classification (NAIC) code |
| 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: |
| FORMCHECKBOX |
a. Sole Ownership
FORMCHECKBOX
b. Partnership
FORMCHECKBOX
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? |
FORMCHECKBOX
a. Yes
FORMCHECKBOX
b. No
| 13. |
| Is the firm a service disabled veteran owned small business? FORMCHECKBOX |
a. Yes
FORMCHECKBOX
b. No
| 14. |
| Is the firm a socially and economically disadvantaged small business? FORMCHECKBOX |
a. Yes
FORMCHECKBOX
b. No
| 15 |
| Is the firm a woman-owned small business? FORMCHECKBOX |
a. Yes
FORMCHECKBOX
b. No
| 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.
Business Declaration (10/2013)
File details come from the government source that posted it. Updated .