consltfm.doc

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OVC Video Project to Help Persons with Disabilities Recognize, Report and Respond to Abuse
Solicitation number
S111708-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 the bidder to disclose any additional income from the Commonwealth of Massachusetts, including political subdivisions or public authorities, as well as any individuals with a financial interest in the contract or with more than a 1% interest in the contractor's capital stock. The bidder must also attach resumes or statements of qualifications for all key personnel to be assigned to the contract performance.

The document does not provide specifics on the products or services requested, project overviews, item quantities, response dates, due dates, site visits, bidder's meetings and conferences, award dates, or the term of the contract. It also does not contain information on pricing terms, set asides, incumbents, current environment, funding requirements and sources, or any other salient details.

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Text version

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 .