BUSINESS DECLARATION_TEM.doc
DOC document 74 KB Posted
- Solicitation number
- 6973GH-26-R-00TBD
About this file
The document is a Business Declaration template used to collect detailed information about a business seeking federal contract opportunities. The form captures comprehensive company details including business ownership characteristics, demographic information, and small business classification status. Key sections include business identification (name, tax ID, DUNS number), ownership type, industry classification (NAICS code), company size (number of employees), and certification status for various small business categories such as 8(a), service-disabled veteran-owned, women-owned, and socially/economically disadvantaged businesses.
The template is specifically designed for federal contracting purposes, with a privacy act statement indicating it will be used by the Federal Aviation Administration (FAA) to determine business ownership and contract eligibility. The form requires a declarative signature affirming the provided information's accuracy, with potential criminal prosecution under 18 USCS 1001 for false statements. The form is structured to help agencies assess a company's qualifications for set-aside contracts and gather statistical information about small business participation in federal procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| Questions and Answers_TEM Solution-10.23.2025.xlsx | XLSX spreadsheet | |
| Questions and Answers_TEM Solution.xlsx | XLSX spreadsheet |
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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 .