consultant contractor mandatory submission form.doc
DOC document 29 KB Posted
- Solicitation number
- BD-15-1046-DFW-FW15-00000000892
- Issued by
- Worcester County, Massachusetts
About this file
This document is a Consultant Contractor Mandatory Submission Form related to a contract opportunity from the Commonwealth of Massachusetts. The form requires the bidder to disclose any additional income from the Commonwealth, individuals with a financial interest in the contract, and resumes for key personnel. The related state and local contract opportunity is for GIS mapping and data entry services to assist the Natural Heritage & Endangered Species Program in Massachusetts with rare species observation data entry and habitat delineation. The contract term is not specified.
The form requires the bidder to certify the accuracy of the information provided under penalties of perjury. Pricing terms, set asides, incumbents, funding amounts and sources, and other salient details are not provided in this document.
View the file
Other files
| File | Type | Posted |
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| standard_contract_frm.doc | DOC document | |
| Prompt_Payment_Discount_Form.doc | DOC document | |
| RFR DFW-2015-001_Data Entry and GIS Mapping.doc | DOC document | |
| contractor_authorized_signature.doc | DOC document | |
| eft_form.pdf | ||
| comm_TermsConditions.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 .