ADV Bidders Qualifications Form

INSTRUCTIONS: Answer all questions on this form by inserting "none" or "not applicable" where appropriate. If more space is required, attach additional sheets. Return the signed, dated and completed form with the bid to the address shown in the Invitation For Bids on or before the time set for the bid opening. The prospective bidder shall provide any additional information requested by the Government during evaluation of the bids.

If the prospective bidder is a joint venture or general partnership, a separate Bidder's Qualifications form shall be provided individually for each joint venture participant or partner.

1. Project Name:ME NP ACAD BRG(2) Solicitation No.: 693C73-27-B-000002 Acadia National Park

Contractor’s SAM Unique Entity ID

Company NameContractor’s DUNS #

StreetContractor’s Employer ID # (EIN)

CityStateZip CodeCounty

Telephone Number (Include Area Code)Fax Number (Include Area Code)

E-mail AddressWeb site address

3. a. Type of organization (check appropriate box):
□ Individual

□ Non-profit organization

□ Corporation

□ Partnership

□ Joint Venture

State
□ Limited Liability Company (LLC)

If a foreign entity:
□ Individual

□ Non-profit organization

□ Corporation

□ Partnership
□ Joint Venture

b. Size of Business Concern (check appropriate boxes):

□ Large Business Concern

□ Small Business Concern

□ Emerging Small Business
Concern
□ Small Disadvantaged
Business Concern
□ Women-Owned Small
Business Concern
□ SBA 8(a) Certified SDBC

□ HUBZone Small Business
Concern

□ Veteran-owned Small
Business Concern

□ Service-Disabled Veteran Owned Small Business Concern

{See FAR Clauses 52.219-1 and 52.219-19 for small business definitions.}

4. If a joint venture or general partnership:

a. Provide the name under which the project will be bid, the home office address, and name of the principal who will represent the company with regard to this project if different from "1." above.

PrincipalSAM Unique Entity ID

Business NameDUNS #

StreetEmployer ID # (EIN)

CityStateZip Code

b. Provide the name and home office addresses of each of the joint venture partners; indicate which partner is the sponsoring partner. Attach a separate sheet for additional partners.

Sponsoring PartnerOther Partner

StreetStreet

CityStateZip CodeCityStateZip Code

7. How many years have you been in business as:

8. a. Furnish the following information concerning the owner, partners, officers and directors:

Name
Title
Percent of Business Owned
Years of
Business Experience