Are you a US citizen with foreign assets? If so, you may need to file Form 25D 6. This form is used to report any foreign financial interests or activities. You must file this form if you meet any of the following criteria: -You have a financial interest in or signature authority over a foreign financial account exceeding $10,000 at any time during the year. -You own more than 50% of the shares of a foreign corporation. -You are otherwise required to file a Report of Foreign Bank and Financial Accounts (FBAR).">Form 25D 6 is used to report any foreign financial interests or activities. You must file this form if you meet any of the following criteria: -You have a financial interest in or signature authority over a foreign financial account exceeding $10,000 at any time during the year. -You own more than 50% of the shares of a foreign corporation. -You are otherwise required to file a Report of Foreign Bank and Financial Accounts (FBAR).">If you are a US citizen with foreign a
| Question | Answer |
|---|---|
| Form Name | Form 25D 6 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Bidderregistrat ion 25d06 state of alaska bidder registration form |
STATE OF ALASKA
DEPARTMENT OF TRANSPORTATION AND PUBLIC FACILITIES
Civil Rights Office – DBE Program
BIDDER REGISTRATION
All firms must register annually or prior to project award with the Alaska Department of Transportation and Public Facilities (DOT&PF) Civil Rights Officer (CRO). Complete this form for each contractor and subcontractor.
Name of Firm:
Street Address:
Mailing Address:
Telephone Number: |
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Fax number: |
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Date Firm was Established: |
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Is this firm a (check all that apply): |
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Prime Contractor? |
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] Yes |
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] No |
Subcontractor? |
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] Yes |
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] No |
Service Provider? |
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] Yes |
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] No |
Material Supplier? |
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] Yes |
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] No |
Manufacturer? |
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] Yes |
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] No |
Certified DBE? * |
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] Yes* |
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] No |
Type of contracts/proposals bid by the firm:
[ ] Highways |
[ ] Airports |
Identify specialty:
Identify service:
Identify material:
Identify product:
*Complete Page 2 of this form
[ ] Mass Transit
[ ] Other (specify) _______________________________________________
Firm’s gross annual receipts: |
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] < $500,000 |
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] $500,000 - $999,999 |
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] $1,000,000 - $4,999,999 |
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] $5,000,000 - $9,999,999 |
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] $10,000,000 - $16,999,999 |
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] > $17,000,000 |
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Signature of Company Representative |
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Date |
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Send this completed form to: |
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You may fax your completed form to: |
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ADOT&PF Civil Rights Office |
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(907) |
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PO Box 196900 |
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Anchorage, Alaska |
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If you have any questions, please call (907)
Form |
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ADDITIONAL INFORMATION REQUIRED
FOR BUSINESSES CERTIFIED IN THE ADOT&PF DBE PROGRAM
Notice to DBE Firms: All businesses are required to submit a Bidder’s Registration form before an ADOT&PF contract can be awarded. The Bidder's Registration form must be submitted on an annual basis by July 1 and is valid through June 30 the following year. DBEs are required to indicate on this form if they wish to be a required contact for prime contractors performing DBE
A.DBE Directory Information
1.Does your firm wish to receive bid solicitations from contractors seeking DBE participation
in your DBE Work Category? (If "No" is checked, skip Questions 2 and 3.) |
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]Yes [ ] No |
2. What ADOT&PF defined region of the state are you willing to work or provide services? |
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] Northern |
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] Central |
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] Southeast |
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[ ] Out of State |
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3.Bid Contact Info.
Name |
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Telephone Number
Email Address
Fax Number
Company Website
Instructions
A.DBE Directory Information (See below for Instructions)
1.Indicate choice by checking "Yes" or "No."
"Yes" means that your firm will be a required contact for contractors demonstrating a GFE. Your firm will be expected to maintain a means of receiving bid request communications and provide responses to contractor's bid requests.
"No" means that your firm does not wish to receive bid solicitations from contractors performing a GFE. Your firm will be listed in the DBE directory. Answering "No" does not change your DBE certification status, however in doing so, you assume full responsibility for notifying contractors that you wish to bid on a specific project.
2.Indicate choice(s) of all that apply to your firm.
3.Bid Contact Information. Please enter the contact person information for the individual in your company that will be responding to GFE bid solicitations. This information will be published in the DBE Directory.
Form |
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