J.P-11_GSA_Form_527.pdf
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- Alliant 2 Unrestricted GWAC Federal contract opportunity
- Solicitation number
- QTA0016JCA0003
- Issued by
- GSA Federal Acquisition Service
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J.P-11 GSA Form 527
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CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION OMB Control Number: 3090-0007 Expiration Date: 9/30/2018
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0007. We estimate that it will take 2.5 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.
SECTION I - GENERAL INFORMATION
1A. NAME
1B. STREET ADDRESS
1C. CITY 1D. STATE 1E. ZIP CODE
2. TYPE OF ORGANIZATION (Check one)
A. SOLE PROPRIETORSHIP
B. GENERAL PARTNERSHIP
C. LIMITED PARTNERSHIP
D. CORPORATION
E. SUBCHAPTER S CORPORATION
I. OTHER (Specify below)
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
D. RETAILER
E. OTHER (Specify) B. FIFO
A. LIFO C. AVERAGE COST
D. OTHER (Specify)
11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS
NAME
10. INVENTORY VALUATION METHOD
9. KIND OF BUSINESS
A. MANUFACTURER
B. CONTRACTOR
C. WHOLESALER
TITLE
(If partner, state G(General) or L(Limited) in column)
ACTUAL TITLE G OR L
PERCENT
BUSINESS OWNED
12. PARENT COMPANY (If applicable)
13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED
INFORMATION IN SECTION VIII, REMARKS YES NO
A. NAME
B. CITY C. STATE
A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY?
B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS?
C. DO YOU HAVE ANY CONTINGENT LIABILITIES?
D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCUSSED BUSINESS OPERATIONS WITHOUT
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)
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 ($)
16. ARE YOU
CURRENTLY
RECEIVING
GOVERNMENT
FINANCING?
YES NO
YES
NO (Go to Section III )
17. COMPLETE ITEMS BELOW IF APPLICABLE
A. INDUSTRIAL REVENUE BONDS
B. GUARANTEED LOANS
C. ADVANCED PAYMENTS
D. PROGRESS PAYMENTS
AUTHORIZED ($) IN USE ($) GOVERNMENT AGENCY INVOLVED
E. OTHER (Specify)
GENERAL SERVICES ADMINISTRATION GSA 527 (REV. 10/2015)
F. LIMITED LIABILITY COMPANY
G. JOINT VENTURE
H. TRUST
TYPE OF FINANCING
GSA 527 (REV. 10/2015) PAGE 2
SECTION III - FINANCIAL STATEMENTS
Prepared Financial Statements with notes may be provided in lieu of completing Section III
When financial statements are prepared or certified by independent accountants and transcribed to this form, please furnish the name and address of accountant of accounting firm.
18. ARE YOU THE INCUMBENT CONTRACTOR FOR THIS SOLICITATION?
NO
19A. NAME
19B. STREET ADDRESS
19C. CITY 19D. STATE 19E. ZIP CODE
20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S,
PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE
LISTED FIGURES ARE:
ACTUAL
IN THOUSANDS
IN MILLIONS
U.S. DOLLARS
FOREIGN CURRENCY (Specify)
21. BALANCE SHEET AS OF (Month, Day, Year) 22. FISCAL YEAR ENDS (Month, Day, Year) 23. PREPARED STATEMENTS
YES
ARE ATTACHED
24. ASSETS 25. LIABILITIES AND NET WORTH
A. Current Assets A. Current Liabilities
Cash Short Term cash investments Accounts receivable, less allowance for doubtful accounts of $ Inventories Other current assets (Itemize below)
Total Current Assets
B. Property, Plant and Equipment
Accounts payable Notes payable (current) Current portion of long term debt Accrued expenses Accrued taxes on income/excess profits Other current liabilities (Itemize below)
Total Current Liabilities
B. Other Liabilities
Land Buildings and equipment Leasehold improvements Less accumulated depreciation and amortization
Total Property, Plant and Equipment C. Other Assets
Investments in and advance to affiliated company Goodwill, less amortization Due from officer, employee Other (Itemize below)
Total Other Assets
D. TOTAL ASSETS
Mortgages Bonds Deferred income taxes Other long term debt
Total Other Liabilities
Total Liabilities
C. Minority Interest in Subsidiary D. Net Worth
Preferred stock Common stock Additional paid-in capital Retained earnings/owner's equity Less, Treasury stock
Total Net Worth
E. TOTAL LIABILITIES AND NET WORTH
SECTION IV - INCOME STATEMENT
26. FROM (Month, Day, Year) 27. TO (Month, Day, Year)
A. Net Sales
28. INCOME
Cost and Expenses Cost of Goods Sold Depreciation and Amortization
Selling, General, and Admin. Expenses Interest Expense Other Expenses (Itemize below)
Minority Interest in Earnings of Subsidiaries
Total Costs and Expenses
Earnings Before Taxes Taxes on Income Income Before Extraordinary Items Extraordinary Gains (Losses) Net of Taxes
NET INCOME (LOSS)
ZIP CODE
Yes No
Yes No
A.
B.
C.
CITY STATE ZIP CODE
Yes No
Yes No
AREA CODE NUMBER
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
37. Maximum Amount Authorized ($)
38. Amount Outstanding ($)
39. Loans Secured by Company's Assets - Real and Personal Property
BANK 1 BANK 2
SECTION V - BANKING AND FINANCE COMPANY INFORMATION
(Please attach a separate sheet using this format for any additional banks.)
ITEM
29. Name of Bank
30. Contact Person
31. Phone Number
32. Fax Number
33. Address
34. Amount Owing ($)
35. Term Loans
36. Line of Credit
D.
SECURED PARTY NAME CONTACT NAME
STREET ADDRESS CITY STATE ZIP CODE
SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)
SECURED PARTY NAME CONTACT NAME
STREET ADDRESS CITY STATE ZIP CODE
SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)
SECURED PARTY NAME CONTACT NAME
STREET ADDRESS CITY STATE ZIP CODE
SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)
SECURED PARTY NAME CONTACT NAME
STREET ADDRESS CITY STATE ZIP CODE
SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)
40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET
PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE?
41B. TOTAL
LIABILITY ($)
41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP,
ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR
FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES
INCLUDED ON THE BALANCE SHEET?
YES NO
42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER?
NO YES (Explain in Section VII, Remarks)
NO YES (Provide detailed information in Section VII, Remarks)
GSA 527 (REV. 10/2015) PAGE 3
AREA CODE NUMBER EXTENSION
STREET ADDRESS
CITY STATE
SECTION VI - PRINCIPAL MERCHANDISE OR RAW MATERIAL SUPPLIER INFORMATION
(Please attach separate sheet(s) using this format for additional suppliers.)
43. PAST DUE ACCOUNTS PAYABLE ($)
ITEM 44. SUPPLIER 1 45. SUPPLIER 2
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
STATECITY ZIP CODE
ITEM 46. SUPPLIER 3 47. SUPPLIER 4
A. Name of Supplier B. Contact Person
C. Telephone
D. Fax
E. Address
F. Amount Now Owing ($) G. High Credit ($)
A. Name of Supplier B. Contact Person
C. Telephone
D. Fax
E. Address
F. Amount Now Owing ($) G. High Credit ($)
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
SECTION VII - CONSTRUCTION/SERVICE CONTRACTS INFORMATION (Public Buildings Service Contracts Only)
CONTRACTS IN FORCE
STREET ADDRESS
CITY STATE ZIP CODE
GSA 527 (REV. 10/2015) PAGE 4
ITEM 48. CONTRACT 1 49. CONTRACT 2
A. Location B. Owner's Name
C. Address
D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
STREET ADDRESS
CITY STATE ZIP CODE
STREET ADDRESS
CITY STATE ZIP CODE
ITEM
A. Location B. Owner's Name
C. Address
D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
50. CONTRACT 3 51. CONTRACT 4
STREET ADDRESS
CITY STATE ZIP CODECITY STATE ZIP CODE
STREET ADDRESS
GSA 527 (REV. 10/2015) PAGE 5
C. Address
D. Telephone
E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
ITEM 58. JOB 3 59. JOB 4
A. Location B. Contact's Name
C. Address
D. Telephone
E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
ITEM 60. JOB 5 61. JOB 6
A. Location B. Contact's Name
C. Address
D. Telephone
E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
ITEM 52. CONTRACT 5 53. CONTRACT 6
A. Location B. Owner's Name
C. Address
D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
STREET ADDRESS
CITY STATE ZIP CODE
STREET ADDRESS
CITY STATE ZIP CODE
ITEM
A. Location B. Owner's Name
C. Address
D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
54. CONTRACT 7 55. CONTRACT 8
STREET ADDRESS
CITY STATE ZIP CODE
STREET ADDRESS
CITY STATE ZIP CODE
LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS
ITEM 56. JOB 1 57. JOB 2
A. Location B. Contact's Name
CERTIFICATION
For the purpose of establishing financial responsibility with, or procuring credit from the General Services Administration, we furnish the above as a true and correct statement of our financial condition and further certify that all other statements are true and correct. There has been no material change in the applicant's financial condition since the date of the above statement. We agree to notify you immediately in writing of any materially unfavorable change in our financial condition. In the absence of such notice or of a new and full financial statement, this is to be considered as a continuing statement.
NAME OF BUSINESS BY (Signature of Authorized Official)
NAME OF AUTHORIZED OFFICIAL (Type or print)
TITLE OF AUTHORIZED OFFICIAL (Type or print)
DATE
GSA 527 (REV. 10/2015) PAGE 6
NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE NUMBER EXTENSION
AREA CODE NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
64. PRESENT AMOUNT OF BONDING
COVERAGE ($)
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).)
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
D. Fax
E. Address
AREA CODE NUMBER EXTENSION
AREA CODE
C:\PERFORM\GSA\G527.FRP
Barbara Williams
CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION
OMB Control Number: 3090-0007 Expiration Date: 9/30/2018 Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0007. We estimate that it will take 2.5 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.
SECTION I - GENERAL INFORMATION
1A. NAME
1B. STREET ADDRESS
1C. CITY
1D. STATE
1E. ZIP CODE
2. TYPE OF ORGANIZATION (Check one)
A. SOLE PROPRIETORSHIP
B. GENERAL PARTNERSHIP
C. LIMITED PARTNERSHIP
D. CORPORATION
E. SUBCHAPTER S CORPORATION
I. OTHER (Specify below)
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
D. RETAILER
E. OTHER (Specify)
B. FIFO
A. LIFO
C. AVERAGE COST
D. OTHER (Specify)
11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS
NAME
10. INVENTORY VALUATION METHOD
9. KIND OF BUSINESS
A. MANUFACTURER
B. CONTRACTOR
C. WHOLESALER
TITLE
(If partner, state G(General) or L(Limited) in column)
ACTUAL TITLE
G OR L
PERCENT
BUSINESS OWNED
12. PARENT COMPANY (If applicable)
13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED
INFORMATION IN SECTION VIII, REMARKS
YES
NO
A. NAME
B. CITY
C. STATE
A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY?
B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS?
C. DO YOU HAVE ANY CONTINGENT LIABILITIES?
D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCUSSED BUSINESS OPERATIONS WITHOUT 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)
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 ($)
16. ARE YOU CURRENTLY
RECEIVING
GOVERNMENT
FINANCING?
YES
NO
YES
NO (Go to Section III )
17. COMPLETE ITEMS BELOW IF APPLICABLE
A. INDUSTRIAL REVENUE BONDS
B. GUARANTEED LOANS
C. ADVANCED PAYMENTS
D. PROGRESS PAYMENTS
AUTHORIZED ($)
IN USE ($)
GOVERNMENT AGENCY INVOLVED
E. OTHER (Specify)
GENERAL SERVICES ADMINISTRATION
GSA 527 (REV. 10/2015)
F. LIMITED LIABILITY COMPANY
G. JOINT VENTURE
H. TRUST
TYPE OF FINANCING
GSA 527 (REV. 10/2015) PAGE 2
SECTION III - FINANCIAL STATEMENTS
Prepared Financial Statements with notes may be provided in lieu of completing Section III When financial statements are prepared or certified by independent accountants and transcribed to this form, please furnish the name and address of accountant of accounting firm.
18. ARE YOU THE INCUMBENT CONTRACTOR FOR THIS SOLICITATION?
NO
19A. NAME
19B. STREET ADDRESS
19C. CITY
19D. STATE
19E. ZIP CODE
20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE
LISTED FIGURES ARE:
ACTUAL
IN THOUSANDS
IN MILLIONS
U.S. DOLLARS
FOREIGN CURRENCY (Specify)
21. BALANCE SHEET AS OF (Month, Day, Year)
22. FISCAL YEAR ENDS (Month, Day, Year)
23. PREPARED STATEMENTS
YES
ARE ATTACHED
24. ASSETS
25. LIABILITIES AND NET WORTH
A. Current Assets A. Current Liabilities Cash Short Term cash investments Accounts receivable, less allowance for doubtful accounts of $ Inventories Other current assets (Itemize below) Total Current Assets B. Property, Plant and Equipment Accounts payable Notes payable (current) Current portion of long term debt Accrued expenses Accrued taxes on income/excess profits Other current liabilities (Itemize below) Total Current Liabilities B. Other Liabilities Land Buildings and equipment Leasehold improvements Less accumulated depreciation and amortization Total Property, Plant and Equipment C. Other Assets Investments in and advance to affiliated company Goodwill, less amortization Due from officer, employee Other (Itemize below) Total Other Assets
D. TOTAL ASSETS
Mortgages Bonds Deferred income taxes Other long term debt Total Other Liabilities Total Liabilities C. Minority Interest in Subsidiary D. Net Worth Preferred stock Common stock Additional paid-in capital Retained earnings/owner's equity Less, Treasury stock Total Net Worth
E. TOTAL LIABILITIES AND NET WORTH
SECTION IV - INCOME STATEMENT
26. FROM (Month, Day, Year)
27. TO (Month, Day, Year) A. Net Sales
28. INCOME
Cost and Expenses Cost of Goods Sold Depreciation and Amortization Selling, General, and Admin. Expenses Interest Expense Other Expenses (Itemize below) Minority Interest in Earnings of Subsidiaries Total Costs and Expenses Earnings Before Taxes Taxes on Income Income Before Extraordinary Items Extraordinary Gains (Losses) Net of Taxes
NET INCOME (LOSS)
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ZIP CODE
Yes No Yes No A.
B.
C.
CITY
STATE
ZIP CODE
Yes No Yes No
AREA CODE
NUMBER
AREA CODE
NUMBER
EXTENSION
AREA CODE
NUMBER
STREET ADDRESS
37. Maximum Amount Authorized ($)
38. Amount Outstanding ($)
39. Loans Secured by Company's Assets - Real and Personal Property
BANK 1
BANK 2
SECTION V - BANKING AND FINANCE COMPANY INFORMATION
(Please attach a separate sheet using this format for any additional banks.)
ITEM
29. Name of Bank
30. Contact Person
31. Phone Number
32. Fax Number
33. Address
34. Amount Owing ($)
35. Term Loans
36. Line of Credit D.
SECURED PARTY NAME
CONTACT NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
SECURING ASSETS
MATURITY DATE
MONTHLY PAYMENT ($)
SECURED PARTY NAME
CONTACT NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
SECURING ASSETS
MATURITY DATE
MONTHLY PAYMENT ($)
SECURED PARTY NAME
CONTACT NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
SECURING ASSETS
MATURITY DATE
MONTHLY PAYMENT ($)
SECURED PARTY NAME
CONTACT NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
SECURING ASSETS
MATURITY DATE
MONTHLY PAYMENT ($)
40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET
PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE?
41B. TOTAL
LIABILITY ($)
41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP,
ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR
FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES
INCLUDED ON THE BALANCE SHEET?
YES
NO
42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER?
NO
YES (Explain in Section VII, Remarks)
NO
YES (Provide detailed information in Section VII, Remarks)
GSA 527 (REV. 10/2015) PAGE 3
AREA CODE
NUMBER
EXTENSION
STREET ADDRESS
CITY
STATE
SECTION VI - PRINCIPAL MERCHANDISE OR RAW MATERIAL SUPPLIER INFORMATION
(Please attach separate sheet(s) using this format for additional suppliers.)
43. PAST DUE ACCOUNTS PAYABLE ($)
ITEM
44. SUPPLIER 1
45. SUPPLIER 2
AREA CODE
NUMBER
EXTENSION
AREA CODE
NUMBER
STREET ADDRESS
STATE
CITY
ZIP CODE
ITEM
46. SUPPLIER 3
47. SUPPLIER 4
A. Name of Supplier B. Contact Person C. Telephone D. Fax E. Address F. Amount Now Owing ($) G. High Credit ($) A. Name of Supplier B. Contact Person C. Telephone D. Fax E. Address F. Amount Now Owing ($) G. High Credit ($)
AREA CODE
NUMBER
EXTENSION
AREA CODE
NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE
NUMBER
EXTENSION
AREA CODE
NUMBER
AREA CODE
NUMBER
EXTENSION
AREA CODE
NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
SECTION VII - CONSTRUCTION/SERVICE CONTRACTS INFORMATION (Public Buildings Service Contracts Only)
CONTRACTS IN FORCE
STREET ADDRESS
CITY
STATE
ZIP CODE
GSA 527 (REV. 10/2015) PAGE 4
ITEM
48. CONTRACT 1
49. CONTRACT 2
A. Location B. Owner's Name C. Address D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
STREET ADDRESS
CITY
STATE
ZIP CODE
STREET ADDRESS
CITY
STATE
ZIP CODE
ITEM
A. Location B. Owner's Name C. Address D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
50. CONTRACT 3
51. CONTRACT 4
STREET ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
STREET ADDRESS
GSA 527 (REV. 10/2015) PAGE 5
C. Address D. Telephone E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE
NUMBER
EXTENSION
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE
NUMBER
EXTENSION
ITEM
58. JOB 3
59. JOB 4
A. Location B. Contact's Name C. Address D. Telephone E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE
NUMBER
EXTENSION
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE
NUMBER
EXTENSION
ITEM
60. JOB 5
61. JOB 6
A. Location B. Contact's Name C. Address D. Telephone E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE
NUMBER
EXTENSION
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE
NUMBER
EXTENSION
ITEM
52. CONTRACT 5
53. CONTRACT 6
A. Location B. Owner's Name C. Address D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
STREET ADDRESS
CITY
STATE
ZIP CODE
STREET ADDRESS
CITY
STATE
ZIP CODE
ITEM
A. Location B. Owner's Name C. Address D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date
54. CONTRACT 7
55. CONTRACT 8
STREET ADDRESS
CITY
STATE
ZIP CODE
STREET ADDRESS
CITY
STATE
ZIP CODE
LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS
ITEM
56. JOB 1
57. JOB 2
A. Location B. Contact's Name
CERTIFICATION
For the purpose of establishing financial responsibility with, or procuring credit from the General Services Administration, we furnish the above as a true and correct statement of our financial condition and further certify that all other statements are true and correct. There has been no material change in the applicant's financial condition since the date of the above statement. We agree to notify you immediately in writing of any materially unfavorable change in our financial condition. In the absence of such notice or of a new and full financial statement, this is to be considered as a continuing statement.
NAME OF BUSINESS
BY (Signature of Authorized Official) NAME OF AUTHORIZED OFFICIAL (Type or print) TITLE OF AUTHORIZED OFFICIAL (Type or print)
DATE
GSA 527 (REV. 10/2015) PAGE 6
NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE
NUMBER
EXTENSION
AREA CODE
NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
64. PRESENT AMOUNT OF BONDING
COVERAGE ($)
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).)
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 D. Fax E. Address
AREA CODE
NUMBER
EXTENSION
AREA CODE
| 1A. NAME: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. E. Address. 62. SURETY COMPANY 1. STREET ADDRESS.: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. E. Address. 62. SURETY COMPANY 1. CITY.: |
| 3. TAXPAYER ID NUMBER: |
| 6. TRADE STYLE NAME (Provide a copy of filing): |
| 8. FORMER BUSINESS NAME: |
| 11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 1 of 5.: |
| 11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. TITLE (If partner, state G (General) or L(Limited) in column). ACTUAL TITLE.: |
| 11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. TITLE (If partner, state G (General) or L(Limited) in column). G OR L.: |
| 11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. PERCENT BUSINESS OWNED.: |
| 11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 2 of 5.: |
| 11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 3 of 5.: |
| 11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 4 of 5.: |
| 11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 5 of 5.: |
| 12. PARENT COMPANY (If applicable). A. NAME.: |
| 12. PARENT COMPANY (If applicable). B. CITY.: |
| 14B. IF "YES", COMPLETE THE ITEMS BELOW. AGENCY.: |
| 15A. AGENCY INVOLVED WITH DELINQUENCY: |
| 9. KIND OF BUSINESS. E. OTHER (Specify).: |
| 12. PARENT COMPANY (If applicable). C. STATE.: |
| 5. STATE OF INCORPORATION: |
| 2. TYPE OF ORGANIZATION (Check one). I. OTHER (Specify below).: |
| 10. INVENTORY VALUATION METHOD. D. OTHER (Specify).: |
| 7. KIND OF PRODUCT OR SERVICE PROVIDED: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. E. Address. 62. SURETY COMPANY 1. STATE.: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. E. Address. 62. SURETY COMPANY 1. ZIP CODE.: |
| 9. KIND OF BUSINESS. A. MANUFACTURER.: 0 |
| 9. KIND OF BUSINESS. B. CONTRACTOR.: 0 |
| 9. KIND OF BUSINESS. C. WHOLESALER.: 0 |
| 9. KIND OF BUSINESS. D. RETAILER.: 0 |
| 9. KIND OF BUSINESS. E. OTHER (Specify).: 0 |
| 2. TYPE OF ORGANIZATION (Check one). A. SOLE PROPRIETORSHIP. : 0 |
| 2. TYPE OF ORGANIZATION (Check one). B. GENERAL PARTNERSHIP.: 0 |
| 2. TYPE OF ORGANIZATION (Check one). C. LIMITED PARTNERSHIP.: 0 |
| 2. TYPE OF ORGANIZATION (Check one). D. CORPORATION.: 0 |
| 2. TYPE OF ORGANIZATION (Check one). E. SUBCHAPTER S CORPORATION.: 0 |
| 10. INVENTORY VALUATION METHOD. A. LIFO.: 0 |
| 10. INVENTORY VALUATION METHOD. B. FIFO.: 0 |
| 10. INVENTORY VALUATION METHOD. C. AVERAGE COST.: 0 |
| 10. INVENTORY VALUATION METHOD. D. OTHER (Specify).: 0 |
| 13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY? YES.: 0 |
| 13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY? NO.: 0 |
| 13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS? YES.: 0 |
| 13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS? NO.: 0 |
| 13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. C. DO YOU HAVE ANY CONTINGENT LIABILITIES? YES.: 0 |
| 13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. C. DO YOU HAVE ANY CONTINGENT LIABILITIES? NO.: 0 |
| 13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. D. HAVE YOU OR ANY OF YOUR AFFILIATES DISC. BUSINESS OPER. WITH OUTSTANDING DEBTS? YES.: 0 |
| 13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. D. HAVE YOU OR ANY OF YOUR AFFILIATES DISC. BUSINESS OPER. WITH OUTSTANDING DEBTS? NO.: 0 |
| 65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). YES.: 0 |
| 65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). YES.: 0 |
| 65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). YES.: 0 |
| 65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). NO.: 0 |
| 65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). NO.: 0 |
| 65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). NO.: 0 |
| 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.: 0 |
| 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.: 0 |
| 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). NO.: 0 |
| 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). NO.: 0 |
| 16. ARE YOU CURRENTLY RECEIVING GOVERNMENT FINANCING? YES.: 0 |
| 16. ARE YOU CURRENTLY RECEIVING GOVERNMENT FINANCING? NO (Go to Section 3).: 0 |
| 2. TYPE OF ORGANIZATION (Check one). F. LIMITED LIABILITY COMPANY.: 0 |
| 2. TYPE OF ORGANIZATION (Check one). G. JOINT VENTURE.: 0 |
| 2. TYPE OF ORGANIZATION (Check one). H. TRUST.: 0 |
| 2. TYPE OF ORGANIZATION (Check one). I. OTHER (Specify below).: 0 |
| 4. DATE ORGANIZATION ESTABLISHED. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 14B. IF "YES", COMPLETE THE ITEMS BELOW. CLAIM AMOUNT.: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. A. INDUSTRIAL REVENUE BONDS. AUTHORIZED ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. E. OTHER (Specify). IN USE ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. E. OTHER (Specify). GOVERNMENT AGENCY INVOLVED.: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. D. PROGRESS PAYMENTS. IN USE ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. C. ADVANCED PAYMENTS. IN USE ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. B. GUARANTEED LOANS. IN USE ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. A. INDUSTRIAL REVENUE BONDS. IN USE ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. B. GUARANTEED LOANS. AUTHORIZED ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. C. ADVANCED PAYMENTS. AUTHORIZED ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. D. PROGRESS PAYMENTS. AUTHORIZED ($).: |
| 17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. E. OTHER (Specify). AUTHORIZED ($).: |
| 14B. IF "YES", COMPLETE THE ITEMS BELOW. PAYMENT.: |
| 14B. IF "YES", COMPLETE THE ITEMS BELOW. MATURITY.: |
| 15B. AMOUNT OF DELINQUENCY ($): |
| 14B. IF "YES", COMPLETE THE ITEMS BELOW. BALANCE.: |
| 20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE ACTUAL.: 0 |
| 20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN THOUSANDS.: 0 |
| 20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN MILLIONS.: 0 |
| 20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN U.S. DOLLARS.: 0 |
| 20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN FOREIGN CURRENCY (Specify).: 0 |
| 19A. NAME: |
| 19B. STREET ADDRESS: |
| 19C. CITY: |
| 24. ASSETS. C. Other Assets. Other (Itemize). Line 3 of 3.: |
| 28. INCOME. A. Net Sales. Other Expenses (Itemize). Line 2 of 2.: |
| 19D. STATE: |
| 19E. ZIP CODE: |
| 20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN FOREIGN CURRENCY (Specify).: |
| 23. PREPARED STATEMENTS ARE ATTACHED.: 0 |
| 22. FISCAL YEAR ENDS (Month, Day, Year). Enter 2 digit month, 2 digit day and 4 digit year.: |
| 21. BALANCE SHEET AS OF (Month, Day, Year). Enter 2 digit month, 2 digit day and 4 digit year.: |
| 26. FROM (Month, Day, Year). Enter 2 digit month, 2 digit day and 4 digit year.: |
| 27. TO (Month, Day, Year). Enter 2 digit month, 2 digit day and 4 digit year.: |
| 24. ASSETS. A. Current Assets. Cash.: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Other current liabilities (Itemize). Line 1 of 2.: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Total Current Liabilities.: |
| 25. LIABILITIES AND NET WORTH. B. Other Liabilities. Mortgages.: |
| 25. LIABILITIES AND NET WORTH. B. Other Liabilities. Bonds.: |
| 25. LIABILITIES AND NET WORTH. B. Other Liabilities. Deferred income taxes.: |
| 25. LIABILITIES AND NET WORTH. B. Other Liabilities. Other long term debt.: |
| 25. LIABILITIES AND NET WORTH. B. Other Liabilities. Total Other Liabilities.: |
| 25. LIABILITIES AND NET WORTH. Total Liabilities.: |
| 25. LIABILITIES AND NET WORTH. C. Minority Interest in Subsidiary.: |
| 25. LIABILITIES AND NET WORTH. D. Net Worth. Preferred Stock.: |
| 25. LIABILITIES AND NET WORTH. D. Net Worth. Common Stock.: |
| 25. LIABILITIES AND NET WORTH. D. Net Worth. Additional paid-in capital.: |
| 25. LIABILITIES AND NET WORTH. D. Net Worth. Retained earnings/owner's equity.: |
| 25. LIABILITIES AND NET WORTH. D. Net Worth. Less, Treasury stock.: |
| 25. LIABILITIES AND NET WORTH. D. Net Worth. Total Net Worth.: |
| 25. LIABILITIES AND NET WORTH. E. TOTAL LIABILITIES AND NET WORTH.: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Other current liabilities.: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Other current liabilities.: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Accrued taxes on income/excess profits.: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Accrued expenses.: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Notes payable (current).: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Current portion of long term debt.: |
| 25. LIABILITIES AND NET WORTH. A. Current Liabilities. Accounts payable.: |
| 24. ASSETS. A. Current Assets. Short Term cash investments.: |
| 24. ASSETS. A. Current Assets. Accounts receivable, less allowance for doubtful accounts of $: |
| 24. ASSETS. A. Current Assets. Inventories.: |
| 24. ASSETS. A. Current Assets. Other current assets.: |
| 24. ASSETS. A. Current Assets. Other current assets.: |
| 24. ASSETS. A. Current Assets. Total Current Assets.: |
| 24. ASSETS. B. Property, Plant and Equipment. Land.: |
| 24. ASSETS. B. Property, Plant and Equipment. Buildings and Equipment.: |
| 24. ASSETS. B. Property, Plant and Equipment. Leasehold improvements.: |
| 24. ASSETS. B. Property, Plant and Equipment. Less accumulated depreciation and amortization.: |
| 24. ASSETS. C. Other Assets. Investments in and advance to affiliated company.: |
| 24. ASSETS. C. Other Assets. Goodwill, less amortization.: |
| 24. ASSETS. C. Other Assets. Due from officer, employee.: |
| 24. ASSETS. C. Other Assets. Other.: |
| 24. ASSETS. C. Other Assets. Other.: |
| 24. ASSETS. C. Other Assets. Other.: |
| 24. ASSETS. C. Other Assets. Total Other Assets.: |
| 28. INCOME. A. Net Sales. Cost and Expenses. Cost of Goods Sold.: |
| 28. INCOME. A. Net Sales. Minority Interest in Earnings of Subsidiaries.: |
| 28. INCOME. Earnings Before Taxes.: |
| 28. INCOME. Taxes on Income.: |
| 28. INCOME. Income Before Extraordinary Items.: |
| 28. INCOME. Extraordinary Gains (Losses) Net of Taxes.: |
| 28. INCOME. NET INCOME (LOSS).: |
| 28. INCOME. A. Net Sales. Total Cost and Expenses.: |
| 28. INCOME. A. Net Sales. Cost and Expenses. Depreciation and Amortization.: |
| 28. INCOME. A. Net Sales. Selling, General, and Admin. Expenses.: |
| 28. INCOME. A. Net Sales. Interest Expense.: |
| 28. INCOME. A. Net Sales. Other Expenses. : |
| 28. INCOME. A. Net Sales. Other Expenses. : |
| 24. ASSETS. D. TOTAL ASSETS.: |
| 24. ASSETS. B. Property, Plant and Equipment. Total Property, Plant and Equipment.: |
| 28. INCOME. A. Net Sales. : |
| 29. Name of Bank. Bank 2.: |
| ITEM. B. Contact Person. 44. SUPPLIER 1.: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. C. Telephone. 62. SURETY COMPANY 1. AREA CODE: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. C. Telephone. 62. SURETY COMPANY 1. NUMBER.: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. C. Telephone. 63. SURETY COMPANY 2. EXTENSION.: |
| 39. Loans Secured by Company's Assets - Real and Personal Property. D. SECURED PARTY NAME.: |
| 39. Loans Secured by Company's Assets - Real and Personal Property. D. CONTACT NAME.: |
| 39. Loans Secured by Company's Assets - Real and Personal Property. C. SECURING ASSETS.: |
| 39. Loans Secured by Company's Assets - Real and Personal Property. A. MONTHLY PAYMENT ($).: |
| 39. Loans Secured by Company's Assets - Real and Personal Property. A. MATURITY DATE. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 41B. TOTAL LIABILITY ($): |
| 34. Amount Owing ($). Bank 2.: |
| 37. Maximum Amount Authorized ($). Bank 2.: |
| 38. Amount Outstanding ($). Bank 2.: |
| 35. Term Loans. Bank 1. Yes.: 0 |
| 36. Line of Credit. Bank 2. No.: 0 |
| 36. Line of Credit. Bank 2. Yes.: 0 |
| 35. Term Loans. Bank 2. No.: 0 |
| 35. Term Loans. Bank 2. Yes.: 0 |
| 35. Term Loans. Bank 1. No.: 0 |
| 36. Line of Credit. Bank 1. Yes.: 0 |
| 36. Line of Credit. Bank 1. No.: 0 |
| 40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE? NO.: 0 |
| 41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP, ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES INCLUDED ON THE BALANCE SHEET? YES.: 0 |
| 41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP, ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES INCLUDED ON THE BALANCE SHEET? NO.: 0 |
| 40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE? YES (Explain in Section 8, Remarks).: 0 |
| 42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER? NO.: 0 |
| 42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER? YES (Provide detailed information in Section 8, Remarks).: 0 |
| ITEM. A. Name of Supplier. 45. SUPPLIER 2.: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. D. Fax. 62. SURETY COMPANY 1. NUMBER.: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. D. Fax. 62. SURETY COMPANY 1. AREA CODE.: |
| ITEM. F. Amount Now Owing ($). 44. SUPPLIER 1.: |
| ITEM. G. High Credit ($). 44. SUPPLIER 1.: |
| CONTRACTS IN FORCE. ITEM. E. Contract Amount ($). 53. CONTRACT 6. : |
| CONTRACTS IN FORCE. ITEM. A. Location. 55. CONTRACT 8.: |
| CONTRACTS IN FORCE. ITEM. B. Owner's Name. 53. CONTRACT 6.: |
| CONTRACTS IN FORCE. ITEM. D. Type of Work. 53. CONTRACT 6. : |
| CONTRACTS IN FORCE. ITEM. F. Percent Completed. 53. CONTRACT 6.: |
| CONTRACTS IN FORCE. ITEM. G. Estimated Completion Date. 52. CONTRACT 5. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 43. PAST DUE ACCOUNTS PAYABLE ($): |
| LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS. ITEM. G. Amount Sublet ($). 60. JOB 5.: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. B. Contact's Name. 62. SURETY COMPANY 1.: |
| LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. A. Company Name. 63. SURETY COMPANY 2.: |
| NAME OF BUSINESS: |
| NAME OF AUTHORIZED OFFICIAL (Type or print): |
| TITLE OF AUTHORIZED OFFICIAL (Type or print): |
| REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).): |
| 64. PRESENT AMOUNT OF BONDING COVERAGE ($): |
| Date of Signature. Enter 2 digit month, 2 digit day and 4 digit year.: |
| BY (Signature of Authorized Official): |
File details come from the government source that posted it. Updated .