consltfm.doc

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Attached to
Press Conference Equipment
Solicitation number
BD-20-1013-COS00-PIO00-44552
Issued by
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, as well as any individuals with a financial interest in the contract or more than 1% interest in the contractor's capital stock. The bidder must also provide resumes or statements of qualifications for all key personnel to be assigned to the contract. The form must be signed by an authorized signatory for the bidder, under the pains and penalties of perjury.

The document does not provide details on the specific 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 mention any pricing terms, set asides, incumbents, current environment, funding requirements and sources, or other salient information.

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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 .