Handbook No. 7460.8 REV 2

            APPENDIX 10. SAMPLE CHECKLIST FOR
            
         DETERMINATION OF CONTRACTOR RESPONSIBILITY
         
         
Public Housing Agency Name: ________________________________________________
____________________________________________________________________________ 			

Solicitation Number: _______________________________________________________			
____________________________________________________________________________

Contractor Name and Address: _______________________________________________
____________________________________________________________________________


            Circle all applicable statements:


1.  A review of the GSA and HUD websites data dated ________ has been conducted and the 
    contractor does/ does not appear as suspended, debarred or operating under a LDP.


2.  The Contractor has/ has not performed satisfactorily on other contract(s) awarded by this 
    PHA.


3.  A survey of other agencies and companies doing business with the contractor was performed. 
    Adverse/ no adverse information has been received that would bring the contractor’s present 
    responsibility and technical capability into question. List the agencies/companies contacted, 
    dated contacted and person providing information.







4.  A review of the Contractor’s financial and technical resources indicates/ does not indicate 
    that it is capable of performing the contract. List documentation reviewed.







5.  State/local government agencies were contacted, and the contractor does/ does not have a 
    record of any outstanding code violations, improper business practices, or similar history of 
    non-compliance with public policy. List agencies contacted.
                     
            
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2/2007

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                                                 Handbook No. 7460.8 REV 2
                                                 
6.  Other pertinent information received does/ does not affect the Contractor’s responsibility. 
    List parties contacted and results of contact (e.g., Better Business Bureau, Business Licenses, 
    Dunn and Bradstreet, other credit agencies).  

In accordance with 24 CFR 85.36 (b)(8), the contractor is considered to be responsible/ non-
responsible and possesses/ does not possess the ability to successfully perform under the terms and 
conditions of this contract. 



_____________________________    ___________________________    ________________
Name                             Signature                      Date
Contracting Officer			  		                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                    
                                                 

                               a-30
                                                                  2/2007

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