J-2-2,_Firm_and_Project_Information.docx

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Attached to
Operational Rooms, Colombia Federal contract opportunity
Solicitation number
SAQMMA17R0127
Issued by
Department of State Office of Acquisition Management

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Attach. J-2-2

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Firm and Project Information Attachment J-2-2

FIRM AND PROJECT INFORMATION

Firm Information

NIT NUMBER

NAME
ADDRESS
TELEPHONE / FAX
E-MAIL ADDRESS

Owners, Partners, and Principle Officer

ENGLISH COMMUNICATION

NAME
POSITION
TELEPHONE
(ABILITY TO UNDERSTAND, WRITE & READ)

Legal Representatives and backups

ENGLISH COMMUNICATION

NAME
POSITION
TELEPHONE
(ABILITY TO UNDERSTAND, WRITE & READ)

Project Director, Key Personnel (see Section H.4.2) and Key Technical Personnel for this Project

ENGLISH COMMUNICATION

NAME
POSITION
TELEPHONE
(ABILITY TO UNDERSTAND, WRITE & READ)

Subcontractors for this Project (if it does not apply, indicate it in the chart)

NAME
ACTIVITY TO PERFORM
% DEL PROJECT TOTAL
TELEPHONE
ADDRESS AND CITY

Suppliers for this Project

NAME
MATERIALS TO SUPPLY
% DEL PROJECT TOTAL
TELEPHONE
ADDRESS AND CITY

Requirement of the Offeror and Owners/Partners

DESCRIPTION
YES
NO
NOTES

Has all licenses and permits required by local law to perform?(Chamber of Commerce, Merchandise Register, Professional Licenses, etc.)

Meets local insurance requirements (Prestaciones Sociales, ICA, Sena, etc.)

Has the ability to obtain a performance and guarantee bond and payment bond, or adequate performance security, such as irrevocable letters of credit or guarantees issued by a reputable financial institution. Include Information

Has adverse criminal record?

Has political or business affiliation which could be considered contrary to the interests of the United States.

I certify that the information is accurate and verifiable

Signature of Legal Representative

Date

Name of Legal Representative

ID Number

Artículo 289 del Código Penal Colombiano: “El que falsifique documento privado que pueda servir de prueba, incurrirá, si lo usa, en prisión de uno (1) a seis (6) años .”

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