consltfm.doc

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Attached to
Game Development: Educating Persons with Disabilities to Recognize, Report and Respond to Abuse
Solicitation number
S112541-vCurrent
Issued by
Norfolk County, Quincy City, Massachusetts

About this file

This document is a Consultant Contractor Mandatory Submission Form for a state and local government contract opportunity. The form requires bidders to disclose any additional income or financial interests from the Commonwealth of Massachusetts, including any political subdivision or public authority, during the contract period. Bidders must also provide resumes or statements of qualifications for any key personnel assigned to the contract. The information submitted on the form is certified by the bidder to be accurate under the pains and penalties of perjury.

The document does not provide details on the specific products or services requested, project overview, quantities, response dates, site visits, award dates, or contract term. It also does not mention pricing terms, set asides, incumbents, funding requirements, or other salient information related to the contract opportunity.

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Consultant Contractor Mandatory Submission Form

COMPLETE THE FOLLOWING ONLY FOR CONSULTANT CONTRACTS

(Within HH and NN and UU Object Classes)

Bidder: ________________________________________________________________________

RFR Name/Title: ________________________________________________________________

RFR Number: # _________________________________________________________________

Additional Income Disclosure. Pursuant to the provisions of M.G.L. c. 29, s. 29A, the following amounts represent any contracts, grants or other income due from the Commonwealth of Massachusetts, including any political subdivision or public authority, during the period of a contract. You may attach additional sheets as necessary.

FORMCHECKBOX

Please check if N/A.

Disclosure of Persons with Financial Interest (other than the bidder). Pursuant to the provisions of M.G.L. c. 29, s 29A and c. 7A, s. 6, the following individuals have a financial interest in a contract and/or with more than one percent (1%) interest in the capital stock of the contractor. You may attach additional sheets as necessary.

FORMCHECKBOX

Please check if N/A.

Key Personnel. Attach a resume or statement of qualifications for all key personnel specifically named in bidder's response to be assigned to the performance of a contract.

FORMCHECKBOX

Please check if N/A.

The information submitted herein is certified by the bidder to be accurate under the pains and penalties of perjury.

Signature of Authorized Signatory for Bidder: __________________________________________________

Title of Authorized Signatory for Bidder: _____________________________________________________

Date: __________________________________________________________

Updated 11/1/05

File details come from the government source that posted it. Updated .