DMVA-23_Sub Contractor Evaluation_Fillable.pdf
PDF 1 MB Posted
- Attached to
- Roof Replacement at Lickdale Facility
- Solicitation number
- 6100061948
- Issued by
- Lawrence County, Pennsylvania
About this file
This document is a Sub-Contractor Evaluation Form from the Commonwealth of Pennsylvania Department of Military and Veterans' Affairs (DMVA). The form is used to collect information about the relationship and financial interests between the Prime Contractor and any Sub-Contractors on a given project. The form requests details on the Prime Contractor's name and address as well as the names, addresses, and ownership information for each Sub-Contractor. The Prime Contractor must indicate whether they have any ownership interest or financial interest in the Sub-Contractor's business.
The form does not provide any details about a specific contract opportunity, project scope, quantities, response dates, award information, or contract terms. It is solely focused on gathering information to identify potential conflicts of interest between the Prime Contractor and its Sub-Contractors.
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Text version
Project No.:
Project Title:
Location:
(1) Relation to Sub-Contractor is defined as: (a) Ownership of more than five percent (5%) in the buisness [or] (b)
(2) Financial Interest with Sub-Contractor is defined as: (a) Holding a five percent (5%) or more ownership of the buisness [and/or]
(b) Holding percent (5%) or more equity such as compensation contracts, trusts, stock holdings, property holdings, or any other interest that would provide a profit to the Prime Contractor.
Commonwealth of Pennsylvania Department of Military and Veterans' Affairs
Building 0-47, Fort Indiantown Gap Annville, PA 17003
Holding a position as an officer, director, trustee, partner, employee, or the like or holding any
DMVA-23
SUB-CONTRACTOR
EVALUATION FORM
Page of
Relation to Sub-Contr.
Y or N (1)
Financial Interest with Sub- Contr. Y or N (2)
Prime Contractor Name & Address
Sub-Contractor (Company Name) Name of Owner
Address
DMVA-23 (REV 1-24)
management type position.
Sheet1
| Project No: |
| Project Title 1: |
| Project Title 2: |
| Project Location: |
| Prime Contractor Name: |
| Company Address: |
| Company Name 00: |
| Company Owner 00: |
| Company Name 01: |
| Company Owner 01: |
| Company Name 02: |
| Company Name 03: |
| Company Owner 02: |
| Company Owner 03: |
| Company Name 04: |
| Company Owner 04: |
| Company Name 05: |
| Company Owner 05: |
| Company Name 06: |
| Company Owner 06: |
| Company Name 07: |
| Company Owner 07: |
| Company Name 08: |
| Company Owner 08: |
| Company Name 09: |
| Company Owner 09: |
| Company Address 00: |
| Company Address 01: |
| Company Address 02: |
| Company Address 03: |
| Company Address 04: |
| Company Address 05: |
| Company Address 06: |
| Company Address 07: |
| Company Address 08: |
| Company Address 09: |
| Y/N 01: |
| Y/N 02: |
| Y/N 03: |
| Y/N 04: |
| Y/N 05: |
| Y/N 06: |
| Y/N 07: |
| Y/N 08: |
| Y/N 09: |
| # 00: |
| # 01: |
| Y/N 00: |
| Y/N 10: |
| Y/N 11: |
| Y/N 12: |
| Y/N 13: |
| Y/N 14: |
| Y/N 15: |
| Y/N 16: |
| Y/N 17: |
| Y/N 18: |
| Y/N 19: |
File details come from the government source that posted it. Updated .