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Gsa Form 527 - Contractor'S Qualifications And Financial Information

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OMB No.: 3090-0007

CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION

Expires:

8/31/2015

Public reporting burden for this collection of information is estimated to average 2.5 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 Financial Information Control Division (BCD), Office of Finance, GSA, Washington, DC 20405; and to

the Office of Management and Budget, Paperwork Reduction Project (3090-0007), Washington, DC 20503.

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

D. OTHER (Specify)

B. FIFO

B. CONTRACTOR

E. OTHER (Specify)

C. WHOLESALER

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS

TITLE

% BUSINESS

(If partner, state G(General) or L(Limited) in column)

NAME

OWNED

ACTUAL TITLE

G OR L

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED

YES

12. PARENT COMPANY (If applicable)

INFORMATION IN SECTION VIII, REMARKS

A. NAME

A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY?

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 DISC. BUSINESS OPER. W/OUTSTANDING DEBTS?

SECTION II - GOVERNMENT FINANCIAL AID AND INDEBTEDNESS

14A. ARE YOU DELINQUENT ON ANY FEDERAL DEBT (OMB CIRCULAR A-129)

YES

(If "Yes", provide detailed information, Section VIII, Remarks)

14B. DO YOU OWE THE

IF "YES", COMPLETE THE ITEMS BELOW

GOVERNMENT

AGENCY

CLAIM AMOUNT

PAYMENT

MATURITY

BALANCE

FOR ANY

CONTRACT OR

OTHER CLAIMS?

YES

15A. AGENCY INVOLVED WITH DELINQUENCY

15B. AMOUNT OF DELINQUENCY ($)

16. ARE YOU

17. COMPLETE ITEMS BELOW IF APPLICABLE

CURRENTLY

TYPE OF FINANCING

AUTHORIZED ($)

IN USE ($)

GOVERNMENT AGENCY INVOLVED

RECEIVING

GOVERNMENT

A. INDUSTRIAL REVENUE BONDS

FINANCING?

B. GUARANTEED LOANS

C. ADVANCED PAYMENTS

YES

D. PROGRESS PAYMENTS

E. OTHER (Specify)

NO (Go to Section III )

GENERAL SERVICES ADMINISTRATION

GSA

527

FORM

(REV. 3-99)

Gsa Form 527 - Contractor'S Qualifications And Financial Information

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