05 - Financial Worksheet.docx
DOCX document 22 KB Posted
- Attached to
- Repair HVAC Systems - Bldg 90141 Hurlburt Field
- Solicitation number
- FA441722B0005
About this file
This solicitation is for the replacement of HVAC system equipment at Building 90141 at Hurlburt Field. The project involves installing a new chilled water system with variable air volume air handling units and variable air volume boxes with electric reheat. Direct digital controls will be used for building level HVAC system controls. The work is required to be completed within 300 calendar days and support the 1st Special Operations Civil Engineer Squadron. The North American Industry Classification System code is 238220 for plumbing, heating, and air conditioning contractors. The contract will be awarded through sealed bidding in accordance with FAR Part 14 and utilize the small business programs under FAR Part 19, with a 100% set aside for women-owned small businesses. The estimated value is between $1 million and $5 million. Bidders must submit bid bonds with their proposals and payment and performance bonds will be required within ten days of award. The solicitation is available on SAM.gov and electronic submission of proposals is anticipated.
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ATTACHMENT 05
FA441722B0005
Financial Reference Worksheet
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your proposal a reference sheet for each financial institution that you have a business account with. This sheet may be sent to the banking institution/s in regards to a determination of contractor responsibility as part of the evaluation for award of this solicitation.
TO BE FILLED OUT BY CONTRACTOR:
COMPANY’S NAME: ____________________________________________________________
Point of Contact (POC) Name: _______________________________________________ POC Phone Number: __________________________________________________________
INSTITUTION NAME: __________________________________________________________
POC name: __________________________________________________________________ POC title: _________________________________________________________________ POC phone number: ______________________ fax number: _______________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 1st Special Operations Contracting Squadron, Hurlburt Field, FL.
| _____________________________________ | ________________________________ | |
| Name/Title | Signature/Date |
DO NOT HAVE THIS SECTION FILLED OUT. IF YOUR FIRM IS SELECTED AS THE POTENTIAL AWARDEE, THIS FORM WILL BE SENT TO YOUR BANKING INSTITUTION FOR COMPLETION.
TO BE FILLED OUT BY FINANCIAL INSTITUTION:
Please give amounts as a range – i.e. low four figures, mid six figures, etc.
Average monthly balance in checking: ________________ Average monthly balance in savings: _________________ Amount of any current loans: ______________ Amount of any lines of credit: ______________ Any late payments or NSF’s? ______________ How long with this institution: ______________ Credit rating with this institution: ______________
I verify that the information provided above is current as of ____________.
| _____________________________________ | ________________________________ | |
| Name/Title | Signature/Date |
File details come from the government source that posted it. Updated .