36C26318R0688-069.docx
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- Solicitation number
- 36C26318R0688
About this file
This solicitation notice is for an Indefinite Delivery Indefinite Quantity (IDIQ) Multiple Award Task Order Contract (MATOC) for construction services within the Minnesota region of Veterans Integrated Service Network 23 (VISN 23). The Department of Veterans Affairs intends to make a minimum of eight awards under this total 100% Service Disabled Veteran Owned Small Business set-aside. The resultant IDIQ contracts will have a five year ordering period for task orders ranging from $2,000 to $10,000,000 to cover maintenance, repair, alteration, and new construction projects at Minneapolis and St. Cloud VA health care systems and their clinics. The seed project cost range is $2,000,000 to $5,000,000 and bonds will be required. The solicitation will be posted on FBO and amendments posted there, with no hard copies distributed. Interested parties must register on the website to receive the solicitation and updates. Offerors must represent that they are an eligible SDVOSB concern under the assigned NAICS code and be verified in Vendor Information Pages and registered in SAM and ORCA systems.
36C26318R0688 ATTACHMENT 5--Contractor Financial Disclosure Questionaire (1 page).docx
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Indefinite Delivery Indefinite Quantity (IDIQ) Contracts Solicitation 36C26318R0688
Solicitation Attachment 5 Financial Disclosure Questionnaire
OFFEROR INSTRUCTIONS: Section A shall be completed by Offeror and submitted to Financial Institution requesting they complete and return to Offeror and included in the RFP offer.
SECTION A:
Prospective Contractor for which information is being requested:
| Contractor Name: | ___________________________________________ | |||
| Address: | ___________________________________________ | |||
| ___________________________________________ | ||||
| Phone Number: | ___________________________________________ | |||
| e-mail: | ___________________________________________ |
Name & Signature of the Person Authorized to request financial information:
FINANCIAL INSTITUTION INSTRUCTIONS: The Department of Veterans Affairs, Network Contracting Office 23 is considering the firm listed above for award of a VA contract. In order to be responsive to VA’s needs, it is requested that you complete this questionnaire and return to the Offeror such that it is included with their RFP offer. Your comments are considered Source Selection Sensitive; therefore, you are advised that Federal Acquisition Regulation FAR-15.506 prohibits the release of the names of individuals providing reference information about Offeror’s financial status.
SECTION B:
Banking Institution: _____________________________________________________________
Account number: ________________________ Type of account:_______ Average balance:__________
Do they have a Line of Credit? [ ] Yes [ ] No
What is their limitation: ________________________ Unused Balance: _________________
Relationship with the bank: [ ] Outstanding [ ] Satisfactory [ ] Other: __________________
How long have they been a client: ______________________________
What is their most recent credit rating: ______________________________
Date of most recent credit rating: ______________________________
Credit rating prepared by: ______________________________
Signature of Provider/Title: ______________________________
Date: ______________________________
SOURCE SELECTION SENSITIVE Page 1 of 1 Attachment 5 FAR 2.101 and 3.104-5
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