Form 1 - Contractor'S Organization Questionnaire/affidavit
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4REQUIRED FORMS - FORM 1
CONTRACTOR’S ORGANIZATION QUESTIONNAIRE/AFFIDAVIT
Please complete, date and sign this form and include it in Section A of the SOQ. The person signing the form
must be authorized to sign on behalf of the Contractor and to bind the applicant in a Master Contract.
Organization Name:
Address:
Organization Telephone:
Facsimile:
E-Mail Address of
Organization Contact
Person:
THIS STATEMENT OF QUALIFICATIONS IS BEING SUBMITTED FOR THE FOLLOWING PROGRAM(S):
Foster Family Agency Foster Care Services (DCFS Children)
Foster Family Agency Foster Care Services (Probation Children)
Group Home Foster Care Services (DCFS Children)
Group Home Foster Care Services (Probation Children)
1.
If your organization is a corporation, state its legal name (as found in your Articles of Incorporation) and
State of incorporation:
_______________________________________________
____________
________
Name
State
Year Inc.
2.
If your organization is a partnership or a sole proprietorship, state the name of the proprietor or managing
partner:
_____________________________________
If your organization is doing business under one or more DBA’s, please list all DBA’s and the County(s)
3.
of registration:
Name
County of Registration
Year became DBA
_____________________________________
_________________
______________
_____________________________________
_________________
______________
4.
Is your organization wholly or majority owned by, or a subsidiary of, another agency? ___________
If yes, Name of parent organization: __________________________________________________
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