consltfm.doc
DOC document 29 KB Posted
- Solicitation number
- BD-14-1100-MMP01-MMP01-00000000377
- Issued by
- Suffolk County, Massachusetts
About this file
The document provided is a Consultant Contractor Mandatory Submission Form relating to a state and local contract opportunity in Massachusetts. The form requires the bidder to provide information about any additional income or financial interests related to the Commonwealth of Massachusetts, as well as key personnel who will be assigned to the contract performance. The state and local contract opportunity is for RFR # 2015-MOTT-01 for Japan Destination Marketing and Public Relations Services. The contract term is not specified.
The form indicates that the bidder must disclose any contracts, grants, or other income due from the Commonwealth of Massachusetts, including any political subdivision or public authority, during the period of the contract. Bidders must also disclose any individuals who have a financial interest in the contract or more than a 1% interest in the capital stock of the contractor. Additionally, bidders must attach resumes or statements of qualifications for all key personnel to be assigned to the contract performance. The information submitted on the form is certified by the bidder to be accurate under the pains and penalties of perjury.
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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
Sensitivity level - low
File details come from the government source that posted it. Updated .