ConsultantContractorMandatorySubmissionForm.doc
DOC document 28 KB Posted
- Attached to
- Underground Storage Tank Program Third Party Claims Administration and Associated Technical Services
- Solicitation number
- S125496-vCurrent
- Issued by
- Suffolk County, Massachusetts
About this file
This document is a Consultant Contractor Mandatory Submission Form for a state and local contract opportunity. The form requires bidders to disclose any additional income from the Commonwealth of Massachusetts, including any political subdivision or public authority, during the period of the contract. Bidders must also disclose any individuals with a financial interest in the contract or more than a 1% interest in the capital stock of the contractor. Key personnel to be assigned to the contract must have their resumes or statements of qualifications attached.
The information submitted on the form is certified by the bidder to be accurate under the pains and penalties of perjury. There is no additional information provided in the document regarding 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 including any renewal options. The document also does not contain any details on pricing terms, set asides, incumbents, current environment, funding requirements and sources, or any 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
File details come from the government source that posted it. Updated .