Atch_12_SF1407.pdf

PREAWARD SURVEY OF PROSPECTIVE

CONTRACTOR

FINANCIAL CAPABILITY

HTC711-15-R-D003

Attachment 12

SERIAL NO. (For surveying activity use) OMB Control Number: 9000-0011

,_P_R_O_S_P_E_C_T-IV_E_C_O_N_T_R_A_C_T_O_R _________ __,Expiration Date: 1/31/2017

Public reporting burden for this collection of informatiqn is estimated to average 24 hours per response, including the time for reviewing instructions, searching existing data sources , gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden , to the Regulatory Secretariat (MVCB), Office of Acquisition Policy, GSA, 1800 F Street, NW, Washington, DC 20405.

SECTION I - RECOMMENDATION

1. RECOMMENDED

D a. COMPLETE AWARD D b. PARTIAL AWARD (Quantity : ------ D c. NO AWARD

2. TOTAL OFFERED PRICE

3. NARRATIVE (Cite those sections of the report which substantiate the recommendation. Give any other backup information in this space or on an additional sheet, if necessary.)

4. SURVEY

a. SIGNATURE

MADE BY

5. SURVEY a. SIGNATURE

REVIEWING

OFFICIAL

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is usable.

IF CONTINUATION SHEETS

ATTACHED- MARK HERE

b. TELEPHONE NUMBER c. DATE SIGNED (Include area code)

D

b. TELEPHONE NUMBER c. DATE REVIEWED (Include area code)

STANDARD FORM 1407 (REV. 1/2014)

Prescribed by GSA- FAR (48 CFR) 53.209-1(e)

1. TYPE OF COMPANY

D CORPORATION

D SUBSIDIARY

D PROPRIETORSHIP

2. YEAR ESTABLISHED:

D PARTNERSHIP

DD1v1s10N

D OTHER (Specify)

SECTION II - GENERAL

3. NAME AND ADDRESS OF:

a. PARENT CO.

b. SUBSIDIARIES

SECTION Ill - BALANCE SHEET/PROFIT AND LOSS STATEMENT

PART A - LATEST BALANCE SHEET PART B - LATEST PROFIT AND LOSS STATEMENT

1. DATE 2. FILED WITH 1. CU RRENT PERIOD 2. FILED WITH

a. FROM b. TO

3. FI NANCIAL POSITION

a. Cash $ a. CURRENT PERIOD $

3. NET SALES

b. Accounts Receivable b. First prior fiscal year

c. Inventory c. Second prior fiscal year

d. Other Current Assets

e. Total Current Assets 4. NET PROFITS a. CURRENT PERIOD $

f. Fixed Assets BEFORE TAXES b. First prior fiscal year

g. Current Liabilit ies c. Second prior fiscal year

h. Long Term Liabilities PART C - OTHER

i. Total Liabilities 1. FISCAL YEAR ENDS (Date) j . Net Worth 2. BALANCE SHEETS

a. THROUGH (Date) b. BY (Signature)

4. WORKING CAPITAL (Current Assets less Current Liabilities)

AND PROFIT AN D LOSS

I

STATEMENTS HAVE

BEEN CERTIFIED

5. RATIOS 3. OTHER PERTINENT DATA

a. CURRENT ASSETS b. ACID TEST (Cash. temporary c. TOTAL LIABILITIES TO CURRENT investments held in lieu of cash TO NET WORTH LIABILITIES and current receivables to current liabilities)

SECTION IV - PROSPECTIVE CONTRACTOR'S FINANCIAL ARRANGEMENTS

Mark "X" in appropriate column. YES NO 4. INDEPENDENT ANALYSIS OF FINANCIAL POSITION SUPPORTS THE STATEMENTS SHOWN IN ITEMS 1, 2, AND 3

1. USE OF OWN RESOURCES DYES D NO (If "NO ", explain)

2. USE OF BANK CREDITS

3. OTHER (Specify)

SECTION V - GOVERNMENT FINANCIAL AID

1. TO BE REQUESTED IN CONNECTION WITH 2. EXPLAIN ANY "YES" ANSWERS TO ITEMS 1a, b, AND c.

PERFORMANCE OF PROPOSED CONTRACT

Mark "X" in appropriate column. YES NO

a. PROGRESS PAYMENT(S)

b. GUARANTEED LOAN

c. ADVANCE PAYMENTS

3. FINANCIAL AID CURRENTLY OBTAINED FROM THE GOVERNMENT

a. PROSPECTIVE Complete items below only if item a. , is marked "YES." CONTRACTOR RECE IVES b. IS LIQUIDATION c. AMOUNT OF UNLIQUIDATED

DOLLAR AMOUNTS (a) AUTHORIZED (b) IN USE GOVERNMENT CURRENT? PROGRESS PAYM ENTS

FINANCING AT OUTSTANDING

PRESENT a. Guaranteed loans $ $

DYES DNo DYES DNo $ b. Advance payments $ $

4. LIST THE GOVERNMENT AGENCIES INVOLVED 5. SHOW THE APPLICABLE CONTRACT NOS.

STANDARD FORM 1407 (REV. 112014) PAGE 2

SECTION VI - BUSINESS AND FINANCIAL REPUTATION

1. COMMENTS OF PROSPECTIVE CONTRACTOR'S BANK

2. COMMENTS OF TRADE CREDITORS

3. COMMENTS AND REPORTS OF COMMERCIAL FINANCIAL SERVICES AND CREDIT ORGANIZATIONS (Such as, Dun & Bradstreet, Standard and Poor, etc.)

4. MOST RECENT

CREDIT RATING

~ a. DATE

5. DOES PRICE APPEAR UNREALISTICALLY LOW?

6. DESCRIBE ANY OUTSTANDING LIENS OR JUDGEMENTS

lb. BY

DYES 0 NO (ff Yes, explain in Section I NARRATIVE)

SECTION VII - SALES (OOO'S) FOR NEXT SIX QUARTERS

CATEGORY 1 2 3 4 5

1. CURRENT CONTRACT SALES (Backlog) $ $ $ $ $ $

A. GOVERNMENT (Prime & Subcontractor)

B. COMMERCIAL

2. ANTICIPATED ADDITIONAL SALES

A. GOVERNMENT (Prime & Subcontractor)

B. COMMERCIAL

3. TOTALS

6 TOTAL

STANDARD FORM 1407 (REV. 1/2014) PAGE 3