3-09 - COM JOC Section J Exhibit A Financial Questionnaire.docx

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CAMP PENDLETON JOC FOR DEMOLITION, REPAIR AND REPLACEMENT OF TELECOMMUNICATIONS OUTSIDE PLANT AND STRUCTURED CABELING THROUGHOUT MARINE CORPS BASE CAMP PENDLETON, CALIFORNIA
Solicitation number
N6247321R3430
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EXHIBIT “A”

FINANCIAL QUESTIONNAIRE

(To be completed and submitted by Financial Institution)

NAVFAC Southwest is currently considering award of a Navy contract to this firm. Prior to award, the Navy requests the financial information listed below with regard to this firm. In order to be responsive to the Navy’s needs, it is requested that you complete this financial questionnaire with regard to this firm. Upon completion of the questionnaire, it is requested that the financial institution shall email the completed Financial Questionnaire directly to the Contract Specialist, Kellee Krause at kellee.krause@navy.mil.

If the financial institution is unable to email the Financial Questionnaire, the financial institution shall mail the completed Financial Questionnaire to the address below:

NAVFAC Southwest, FEAD Camp Pendleton ATTN: Kellee Krause Building 22101 9th Street, Box 555229 Camp Pendleton, CA 92055-5299

Offeror is required to notify the Contract Specialist if the financial institution will mail the Financial Questionnaire.

The requested information must be received by the contractor no later than 12:00 PM (PST) on July 19, 2021.

Prospective Contractor for which information is being requested:

Name:
Address:
Phone Number:
Point of Contact::

Signature of Prospective Contractor or Contractor Representative Requesting Financial Information

Name of Financial Institution:
Address:
Phone Number:
Account Number:
Type of Account:
Average Balance Figure :

Does the Contractor have a line of credit? |_| Yes |_| No

What is the limitation?
Remaining Balance:

What is the Contractor’s relationship with the bank?

|_| Outstanding |_| Satisfactory |_| Other (explain):
How long has the Contractor been a client?
Name and Title of person providing the above information:

Signature of person providing the above information

Please provide any additional comments that may help determine the business and financial reputation and integrity of the prospective contractor on a separate sheet.

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