Gsa Form 527 PDF Details

In the world of government contracting, transparency and financial stability are non-negotiable, which brings into focus the significance of the General Services Administration (GSA) Form 527, titled "Contractor's Qualifications and Financial Information." This form serves as a comprehensive tool, designed to collect a wide range of data from contractors aspiring to engage in business with government entities. Its content spans from general organizational details, such as the type of establishment and taxpayer identification number, to more specific financial data including inventory valuation methods, ownership details, and the fiscal health of the business. Additionally, it seeks information on any government financial assistance, income statements, and banking and finance details critical for assessing the financial stability and integrity of a contractor. Important too is the insight it offers into a contractor’s past performance and obligations, by probing for information on past bankruptcies, pending suits, or defaults on obligations. With its detailed sections and the requirement for prepared financial statements, the GSA Form 527 not only facilitates an understanding of a contractor's current financial standing but also acts as a vehicle for due diligence, aimed at preventing fraud and ensuring that only financially responsible entities engage in government contracts. Mandated every three years, this document underscores the government’s commitment to fiscal responsibility and operational integrity in its contractual engagements.

QuestionAnswer
Form NameGsa Form 527
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesGSA_Form_527_fo r_SIN_246 54_Only gsa form 527 fillable

Form Preview Example

CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION

OMB No.: 3090-0007

Expires: 1/31/2005

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.

CONTRACTOR

 

F. OTHER (Specify)

 

B. FIFO

 

 

 

C.WHOLESALER

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS

NAME

TITLE

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

ACTUAL TITLE

G OR L

 

 

%BUSINESS OWNED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. PARENT COMPANY (If applicable)

 

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

YES

NO

 

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

YES

NO

14B. DO YOU OWE THE

 

 

IF "YES", COMPLETE THE ITEMS BELOW

 

 

GOVERNMENT

 

 

 

 

 

 

 

 

 

 

 

FOR ANY CON-

 

AGENCY

 

CLAIM AMOUNT

PAYMENT

MATURITY

BALANCE

TRACT OR OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLAIMS?

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

15A. AGENCY INVOLVED WITH DELINQUENCY

 

 

 

15B. AMOUNT OF DELINQUENCY ($)

 

 

 

 

 

 

 

 

16. ARE YOU CURR-

 

 

17. COMPLETE ITEMS BELOW IF APPLICABLE

 

 

RENTLY RECEIVING

 

 

 

 

 

 

 

 

 

 

 

GOVERNMENT

 

TYPE OF FINANCING

AUTHORIZED ($)

IN USE ($)

GOVERNMENT AGENCY INVOLVED

FINANCING?

 

 

 

 

 

 

 

A.

INDUSTRIAL REVENUE BONDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

B.

GUARANTEED LOANS

 

 

 

 

 

 

 

C.

ADVANCED PAYMENTS

 

 

 

 

 

NO (Go to Section III) D. PROGRESS PAYMENTS

E.OTHER (Specify)

GENERAL SERVICES ADMINISTRATION

GSA FORM 527 (REV. 3-99)

SECTION III - FINANCIAL STATEMENTS

Prepared Financial Statements with notes may be provided in lieu of completing Section III

When financial statements are prepared or certified by independent accountants and transcribed

18. ARE YOU THE INCUMBENT CONTRACTOR FOR THIS SOLICITATION

 

 

 

 

 

to this form, please furnish the name and address of accountant of accounting firm.

 

 

YES

 

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

19A. NAME

 

 

 

 

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S,

 

 

 

 

 

 

 

 

 

 

 

PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE

 

 

 

 

 

 

 

LISTED FIGURES ARE:

19B. STREET ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACTUAL

 

 

U.S. DOLLARS

 

 

 

 

 

 

 

 

 

 

 

19C. CITY

19D. STATE

19E. ZIP CODE

 

IN THOUSANDS

 

 

FOREIGN CURRENCY (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IN MILLIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21. BALANCE SHEET AS OF (Month, Day, Year)

 

 

 

22. FISCAL

YEAR

ENDS (Month, Day, Year)

 

 

 

23. PREPARED STMTS.

 

 

 

 

 

 

 

 

 

 

 

ARE ATTACHED

 

 

 

 

 

 

 

24. ASSETS

 

 

25. LIABILITIES AND NET WORTH

 

 

 

 

 

 

 

 

 

 

A. Current Assets

 

 

 

 

A. Current Liabilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash

 

 

 

 

 

Accounts payable

 

 

 

 

Short Term cash investments

 

 

 

 

 

Notes payable (current)

 

 

 

 

Accounts receivable, less allowance for

 

 

Current portion of long term debt

 

doubtful accounts of $

 

 

 

 

 

Accrued expenses

 

 

 

 

Inventories

 

 

 

 

 

Accrued taxes on income/excess profits

 

Other current assets (Itemize below)

 

 

Other current liabilities (Itemize)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Current Assets

 

 

 

Total Current Liabilities

 

B. Property, Plant and Equipment

 

 

 

 

B. Other Liabilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Land

 

 

 

 

 

Mortgages

 

 

 

 

Buildings and equipment

 

 

 

 

 

Bonds

 

 

 

 

 

Leasehold improvements

 

 

 

 

 

Deferred income taxes

 

 

 

 

Less accumulated depreciation and

 

 

 

 

 

Other long term debt

 

 

 

 

amortization

 

 

 

 

 

 

Total Other Liabilities

 

 

 

 

 

 

 

 

 

Total Property, Plant and Equipment

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Other Assets

 

 

 

 

 

 

 

Total Liabilities

 

 

 

 

 

 

 

 

 

 

Investments in and advance to affiliated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

company

 

 

 

 

C. Minority Interest in Subsidiary

 

Goodwill, less amortization

 

 

 

 

D. Net Worth

 

 

 

 

Due from officer, employee

 

 

 

 

 

Preferred stock

 

 

 

 

Other (Itemize)

 

 

 

 

 

Common stock

 

 

 

 

 

 

 

 

 

 

Additional paid-in capital

 

 

 

 

 

 

 

 

 

 

Retained earnings/owner's equity

 

 

 

 

 

 

 

Less, Treasury stock

 

 

 

 

Total Other Assets

 

 

 

 

 

 

Total Net Worth

 

D. TOTAL ASSETS

 

 

E. TOTAL LIABILITIES AND NET WORTH

 

 

 

 

 

 

 

 

 

 

 

SECTION IV - INCOME STATEMENT

 

 

 

 

26. FROM (Month, Day, Year)

27. TO (Month, Day, Year)

 

28. INCOME

 

 

 

 

A. Net Sales

 

Minority Interest in Earnings of

 

Cost and Expenses

 

Subsidiaries

 

 

 

 

 

Cost of Goods Sold

 

Total Costs and Expenses

 

Depreciation and Amortization

 

 

 

 

 

Selling, General, and Admin. Expenses

 

Earnings Before Taxes

 

Interest Expense

 

Taxes on Income

 

Other Expenses (Itemize)

 

Income Before Extraordinary Items

 

 

 

Extraordinary Gains (Losses) Net of Taxes

 

 

 

NET INCOME (LOSS)

 

 

 

GSA FORM 527 (REV.3-99 ) PAGE 2

SECTION V - BANKING AND FINANCE COMPANY INFORMATION

(Please attach a separate sheet using this format for any additional banks.)

ITEM

 

BANK 1

 

 

 

BANK 2

 

 

 

 

 

 

 

 

 

 

 

 

 

29.Name of Bank

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

30.Contact

 

 

 

 

 

 

 

 

 

 

Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31.Phone Number

AREA CODE

NUMBER

 

EXT.

AREA CODE

NUMBER

 

EXT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32.Fax Number

AREA CODE

NUMBER

 

 

AREA CODE

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

STREET ADDRESS

 

 

 

 

33.Address

 

 

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34.Amount

 

 

 

 

 

 

 

 

 

 

Owing ($)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35.Term Loans

Yes

 

No

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

36.Line of Credit

Yes

 

No

 

 

Yes

 

No

 

 

37.Maximum Amount Authorized ($)

38.Amount Outstanding ($)

39. Loans Secured by Company's Assets - Real and Personal Property

 

SECURED PARTY NAME

 

 

 

CONTACT NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A.

STREET ADDRESS

 

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

SECURING ASSETS

 

 

 

 

 

MATURITY DATE

MONTHLY

PAYMENT ($)

 

 

 

 

 

 

 

 

 

 

 

SECURED PARTY NAME

 

 

 

CONTACT NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B.

STREET ADDRESS

 

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

SECURING ASSETS

 

 

 

 

 

MATURITY DATE

MONTHLY

PAYMENT ($)

 

 

 

 

 

 

 

 

 

 

 

SECURED PARTY NAME

 

 

 

CONTACT NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C.

STREET ADDRESS

 

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

SECURING ASSETS

 

 

 

 

 

MATURITY DATE

MONTHLY

PAYMENT ($)

 

 

 

 

 

 

 

 

 

 

 

SECURED PARTY NAME

 

 

 

CONTACT NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.

STREET ADDRESS

 

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

SECURING ASSETS

 

 

 

 

 

MATURITY DATE

MONTHLY

PAYMENT ($)

 

 

 

 

 

 

40.

ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET

41A.

IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP, ARE 41B. TOTAL

 

PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE?

 

THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR FEDERAL

LIABILITY ($)

 

 

 

 

AND STATE INCOME AND/OR EXCESS PROFIT TAXES INCLUDED ON

 

 

 

 

 

THE BALANCE SHEET?

 

 

 

 

 

NO

YES (Explain in Section VII, Remarks)

 

YES

NO

 

 

42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER?

NO

YES (Provide detailed information in Section VII, Remarks)

GSA FORM 527 (REV. 3-99) PAGE 3

SECTION VI - PRINCIPAL MERCHANDISE OR RAW MATERIAL SUPPLIER INFORMATION

(Please attach separate sheet(s) using this format for additional suppliers.)

43. PAST DUE ACCOUNTS PAYABLE ($)

 

ITEM

 

44. SUPPLIER 1

 

 

 

45. SUPPLIER 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Name of Supplier

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B.

Contact Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Telephone

AREA CODE

NUMBER

 

EXT.

AREA CODE

NUMBER

 

EXT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Fax

AREA CODE

NUMBER

 

 

AREA CODE

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

STREET ADDRESS

 

 

 

 

 

E.

Address

 

 

 

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F.

Amount Now

 

 

 

 

 

 

 

 

 

 

 

 

Owing ($)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G.

High Credit ($)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM

 

46. SUPPLIER 3

 

 

 

47. SUPPLIER 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Name of Supplier

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B.

Contact Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Telephone

AREA CODE

NUMBER

 

EXT.

AREA CODE

NUMBER

 

EXT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Fax

AREA CODE

NUMBER

 

 

AREA CODE

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

STREET ADDRESS

 

 

 

 

 

E.

Address

 

 

 

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F.

Amount Now

 

 

 

 

 

 

 

 

 

 

 

 

Owing ($)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. High Credit ($)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION

VII - CONSTRUCTION/SERVICE CONTRACTS INFORMATION (Public Buildings Service Contracts Only)

 

 

 

 

 

CONTRACTS IN FORCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM

 

48. CONTRACT 1

 

 

 

49. CONTRACT 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A. Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Owner's Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

STREET ADDRESS

 

 

 

 

 

C. Address

 

 

 

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.Type of Work

E.Contract Amt. ($)

F.% Completed

G.Est. Comp. Date

ITEM

50. CONTRACT 3

51. CONTRACT 4

 

 

 

A.Location

B.Owner's Name

STREET ADDRESS

STREET ADDRESS

C. Address

CITY

STATE ZIP CODE

CITY

STATE ZIP CODE

 

D.Type of Work

E.Contract Amt. ($)

F.% Completed

G.Est. Comp. Date

GSA FORM 527 (REV. 3-99) PAGE 4

ITEM

 

52. CONTRACT 5

 

53. CONTRACT 6

 

 

 

 

 

 

 

 

 

A. Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. Owner's Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

STREET ADDRESS

 

 

 

C. Address

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

D.Type of Work

E.Contract Amt. ($)

F.% Completed

G.Est. Comp. Date

ITEM

54. CONTRACT 7

55. CONTRACT 8

 

 

 

A.Location

B.Owner's Name

STREET ADDRESS

STREET ADDRESS

C. Address

CITY

STATE ZIP CODE

CITY

STATE ZIP CODE

 

D.Type of Work

E.Contract Amt. ($)

F.% Completed

G.Est. Comp. Date

 

LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS

ITEM

56. JOB 1

57. JOB 2

A.Location

B.Contact's Name

STREET ADDRESS

STREET ADDRESS

C. Address

 

 

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Telephone

AREA CODE

NUMBER

 

 

EXT.

AREA CODE

NUMBER

 

 

EXT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Type of Work

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F. Contract Amt. ($)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. Amount Sublet ($)

 

 

 

 

 

 

 

 

 

 

ITEM

 

58. JOB 3

 

 

 

59. JOB 4

 

 

A.Location

B.Contact's Name

STREET ADDRESS

STREET ADDRESS

C. Address

 

 

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Telephone

AREA CODE

NUMBER

 

 

EXT.

AREA CODE

NUMBER

 

 

EXT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Type of Work

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F. Contract Amt. ($)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. Amount Sublet ($)

 

 

 

 

 

 

 

 

 

 

ITEM

 

60. JOB 5

 

 

 

61. JOB 6

 

 

A.Location

B.Contact's Name

STREET ADDRESS

STREET ADDRESS

C. Address

 

 

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Telephone

AREA CODE

NUMBER

 

 

EXT.

AREA CODE

NUMBER

 

 

EXT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E.

Type of Work

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F.

Contract Amt. ($)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G.

Amount Sublet ($)

 

 

 

 

 

 

 

 

 

 

GSA FORM 527 (REV. 3-99) PAGE 5

 

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS

ITEM

62. SURETY COMPANY 1

63. SURETY COMPANY 2

A.Company Name

B.Contact's Name

C. Telephone

AREA CODE

NUMBER

 

 

EXT.

AREA CODE

NUMBER

 

EXT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Fax

AREA CODE

NUMBER

 

 

 

AREA CODE

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

STREET ADDRESS

 

 

 

 

E. Address

 

 

 

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

64. PRESENT AMOUNT OF BONDING

65. HAS YOUR

APPLICATION

FOR SURETY

66. DURING THE PAST 2 YEARS, HAVE

YOU BEEN

CHARGED WITH A

COVERAGE ($)

 

BOND EVER BEEN DECLINED (If Yes, please

FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR

 

 

provide detailed information in Remarks)

SUPPLIERS (If Yes, please provide detailed information in Remarks)

 

 

YES

NO

YES

 

NO

 

 

SECTION VIII - REMARKS

REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).)

CERTIFICATION

For the purpose of establishing financial responsibility with, or procuring credit from the General Services Administration, we furnish the above as a true and correct statement of our financial condition and further certify that all other statements are true and correct. There has been no material change in the applicant's financial condition since the date of the above statement. We agree to notify you immediately in writing of any materially unfavorable change in our financial condition. In the absence of such notice or of a new and full financial statement, this is to be considered as a continuing statement.

NAME OF BUSINESS

BY (Signature of Authorized Official)

NAME OF AUTHORIZED OFFICIAL (Type or print)

DATE

 

 

TITLE OF AUTHORIZED OFFICIAL (Type or print)

 

 

 

GSA FORM 527 (REV. 3-99) PAGE 6

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