21R0004 Attachment 3 Financial Reference Sheet.pdf
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- Attached to
- Mess Attendant Services Federal contract opportunity
- Solicitation number
- FA441721R0004
About this file
This document contains an attachment requesting financial reference information from contractors bidding on solicitation number FA441721R0004 for Mess Attendant Services. The solicitation seeks proposals to provide all personnel, supervision, and any items or services necessary to perform mess attendant and contingency cook services at two dining facilities on Hurlburt Field, Florida. Specific requirements include food preparation, service, cleaning, cashier services, housekeeping, waste management, grounds maintenance, and equipment maintenance and repair for the dining facilities. Contractors must include a completed financial reference sheet from each financial institution where they hold business accounts, providing information such as average monthly balances, current loans, lines of credit, late payments or non-sufficient funds history, and credit rating to be verified by the institution. This will be used to assess contractor responsibility as part of the evaluation and award process for the solicitation.
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Text version
FA441721R0004
Attachment 3
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
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