consltfm.doc
DOC document 29 KB Posted
- Attached to
- Event and Emergency Services Contracts
- Solicitation number
- BD-21-1013-CAO00-FISCL-53857
- Issued by
- Middlesex County, Massachusetts
About this file
The document is a Consultant Contractor Mandatory Submission Form for a state and local contract opportunity. The contract opportunity is for Event and Emergency Services Contracts in the state of Massachusetts. The form requires the bidder to disclose any additional income from the Commonwealth of Massachusetts, individuals with financial interest in the contract, and the qualifications of key personnel to be assigned. The contract opportunity does not provide additional details on the scope of work, response deadlines, award dates, contract term, or renewal options.
The document does not contain information on pricing terms, set asides, incumbents, funding requirements and sources, or other salient details about the contract opportunity. The form is focused on the bidder disclosure requirements rather than the specifics of the contract opportunity.
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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 .