consultant contractor mandatory submission form.doc
DOC document 29 KB Posted
- Attached to
- DFW-2015-003_Preparation of Piping Plover Statewide Habitat Conservation Plan and Associated Environ
- Solicitation number
- BD-15-1046-DFW-FW15-00000000945
- Issued by
- Worcester County, Massachusetts
About this file
This document is a Consultant Contractor Mandatory Submission Form for a state and local contract opportunity. The contract opportunity is for the preparation of a Piping Plover Habitat Conservation Plan (HCP) and Environmental Assessment (EA) for the Massachusetts Division of Fisheries & Wildlife (DFW) under RFR # DFW-2015-003. The document requires the bidder to disclose any additional income from the Commonwealth of Massachusetts, individuals with a financial interest in the contract, and key personnel to be assigned to the contract performance.
The contract opportunity is for consulting services related to the preparation of the Piping Plover HCP and EA pursuant to the Endangered Species Act and the National Environmental Policy Act. No pricing terms, set asides, incumbents, funding requirements or sources, or other salient information is provided in the document.
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Other files
| File | Type | Posted |
|---|---|---|
| comm_TermsConditions.doc | DOC document | |
| contractor_authorized_signature.doc | DOC document | |
| DFW-2015-003_Preparation of Piping Plover Statewide Habitat Conservation Plan and Associated Environmental Assessment.doc | DOC document | |
| eft_form.pdf | ||
| Prompt_Payment_Discount_Form.doc | DOC document | |
| standard_contract_frm.doc | DOC document | |
| newMass_W9.doc | DOC document |
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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 .