GSA527 Contractor Qualifications.pdf
PDF 190 KB Posted
- Attached to
- Weld County CBOC
- Solicitation number
- 36C24W26R0049
- Issued by
-
Department of Veterans Affairs
About this file
This is a federal contractor financial qualification and capability form used by the U.S. General Services Administration (GSA) to assess financial responsibility and technical competence of contractors seeking to establish or maintain credit relationships with the government.
The form captures comprehensive business information including company name, organization type (sole proprietorship, corporation, partnership, LLC, joint venture, or trust), tax identification number, incorporation details, and primary business classification (manufacturer, contractor, wholesaler, retailer, or other). Section I requires ownership structure information for partners and principal stockholders with percentage ownership details. Section II addresses government financial aid and indebtedness, requiring disclosure of federal debt delinquencies, outstanding government claims, contingent liabilities, bankruptcy history, judgments, liens, and pending litigation. Applicants must detail any current government financing received, including industrial revenue bonds, guaranteed loans, advanced payments, and progress payments with authorization and usage amounts.
Sections VII and VIII focus on construction and service contract experience, requiring contractors to document up to four contracts currently in force and six of the largest jobs completed in the past five years, including location, owner contact information, work type, contract amounts, completion percentages, and sublet amounts. The form also requires identification of surety bond providers with contact and address information, present bonding coverage amounts, and disclosure of any declined bond applications or failures to meet subcontractor or supplier claims within the past two years. The certification section obligates the authorized official to attest that all information is true, correct, and current, with commitment to notify GSA immediately of any materially unfavorable financial changes.
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Text version
SECTION I - GENERAL INFORMATION
1A. NAME 2. TYPE OF ORGANIZATION (Check one)
A. SOLE PROPRIETORSHIP F. LIMITED LIABILITY COMPANY
1B. STREET ADDRESS B. GENERAL PARTNERSHIP G. JOINT VENTURE
C. LIMITED PARTNERSHIP H. TRUST
1C. CITY 1D. STATE 1E. ZIP CODE D. CORPORATION I. OTHER (Specify below)
E. SUBCHAPTER S CORPORATION
3. TAXPAYER ID NUMBER 4. DATE ORGANIZATION ESTABLISHED 5. STATE OF INCORPORATION
6. TRADE STYLE NAME (Provide a copy of filing) 7. KIND OF PRODUCT OR SERVICE PROVIDED
8. FORMER BUSINESS NAME 10. INVENTORY VALUATION METHOD
A. LIFO
C. AVERAGE COST
9. KIND OF BUSINESS
A. MANUFACTURER D. RETAILER
B. FIFO
D. OTHER (Specify) B. CONTRACTOR E. OTHER (Specify)
C. WHOLESALER
11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS
NAME
TITLE
(If partner, state G(General) or L(Limited) in column) PERCENT
BUSINESS OWNED
ACTUAL TITLE G OR L
12. PARENT COMPANY (If applicable)
13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED
INFORMATION IN SECTION VIII, REMARKS YES NO
A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY?
A. NAME
B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS?
B. CITY C. STATE C. DO YOU HAVE ANY CONTINGENT LIABILITIES?
D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCONTINUED BUSINESS
OPERATIONS WITH OUTSTANDING DEBTS?
SECTION II - GOVERNMENT FINANCIAL AID AND INDEBTEDNESS
14A. ARE YOU DELINQUENT ON ANY FEDERAL DEBT (OMB CIRCULAR A-129)
(If "Yes", provide detailed information, Section VIII, Remarks)
YES NO
14B. DO YOU OWE THE
GOVERNMENT
FOR ANY
CONTRACT OR
OTHER CLAIMS?
YES NO
IF "YES", COMPLETE THE ITEMS BELOW
AGENCY CLAIM AMOUNT PAYMENT MATURITY BALANCE
15A. AGENCY INVOLVED WITH DELINQUENCY 15B. AMOUNT OF DELINQUENCY ($)
16. ARE YOU
CURRENTLY
RECEIVING
GOVERNMENT
FINANCING?
YES
NO (Go to Section III )
17. COMPLETE ITEMS BELOW IF APPLICABLE
TYPE OF FINANCING AUTHORIZED ($) IN USE ($) GOVERNMENT AGENCY INVOLVED
A. INDUSTRIAL REVENUE BONDS
B. GUARANTEED LOANS
C. ADVANCED PAYMENTS
D. PROGRESS PAYMENTS
E. OTHER (Specify)
CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION
SECTION VII - CONSTRUCTION/SERVICE CONTRACTS INFORMATION (Public Buildings Service Contracts Only)
CONTRACTS IN FORCE
ITEM 48. CONTRACT 1 49. CONTRACT 2
A. Location
B. Owner's Name
C. Address
STREET ADDRESS STREET ADDRESS
CITY STATE ZIP CODE CITY STATE ZIP CODE
D. Type of Work
E. Contract Amount ($)
F. Percent Completed
G. Estimated Completion Date
ITEM 50. CONTRACT 3 51. CONTRACT 4
B. Owner's Name
CITY STATE ZIP CODE CITY STATE ZIP CODE
D. Type of Work
E. Contract Amount ($)
F. Percent Completed
G. Estimated Completion Date
LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS
ITEM 56. JOB 1 57. JOB 2
B. Contact's Name
CITY STATE ZIP CODE CITY STATE ZIP CODE
D. Telephone
AREA CODE NUMBER EXTENSION AREA CODE NUMBER EXTENSION
E. Type of Work
F. Contract Amount ($)
G. Amount Sublet ($)
ITEM 58. JOB 3 59. JOB 4
CITY STATE ZIP CODE CITY STATE ZIP CODE
D. Telephone
AREA CODE NUMBER EXTENSION AREA CODE NUMBER EXTENSION
E. Type of Work
F. Contract Amount ($)
G. Amount Sublet ($)
ITEM 60. JOB 5 61. JOB 6
CITY STATE ZIP CODE CITY STATE ZIP CODE
D. Telephone
AREA CODE NUMBER EXTENSION AREA CODE NUMBER EXTENSION
E. Type of Work
F. Contract Amount ($)
G. Amount Sublet ($)
LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS
ITEM 62. SURETY COMPANY 1 63. SURETY COMPANY 2
A. Company Name B. Contact's Name
C. Telephone
AREA CODE NUMBER EXTENSION AREA CODE NUMBER EXTENSION
D. Fax
AREA CODE NUMBER AREA CODE NUMBER
E. Address
CITY STATE ZIP CODE CITY STATE ZIP CODE
64. PRESENT AMOUNT OF BONDING
COVERAGE ($)
65. HAS YOUR APPLICATION FOR SURETY
BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in
Remarks)
66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A
FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR
SUPPLIERS? (If Yes, please provide detailed information in Remarks)
YES NO YES NO
SECTION VIII - REMARKS
REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).)
CERTIFICATION
For the purpose of establishing financial responsibility with, or procuring credit from the U.S. General Services Administration, we furnish the above as a true and correct statement of our financial condition and further certify that all other statements are true and correct. There has been no material change in the applicant's financial condition since the date of the above statement. We agree to notify you immediately in writing of any materially unfavorable change in our financial condition. In the absence of such notice or of a new and full financial statement, this is to be considered as a continuing statement.
NAME OF BUSINESS BY (Signature of Authorized Official)
NAME OF AUTHORIZED OFFICIAL (Type or print) DATE
TITLE OF AUTHORIZED OFFICIAL (Type or print)
| SECTION I - GENERAL INFORMATION |
| SECTION II - GOVERNMENT FINANCIAL AID AND INDEBTEDNESS |
| SECTION VIII - REMARKS |
| CERTIFICATION |
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