A15 Attachment 4 Responsibility Questionnaire Remodel B302.docx
DOCX document 20 KB Posted
- Attached to
- Convert Corrosion Control B302/Composite Shop Federal contract opportunity
- Solicitation number
- FA665624B0002
About this file
This document is a Responsibility Questionnaire, which is part of the Solicitation FA665624B0002 for the project to Convert Corrosion Control B302/Composite Shop. The Responsibility Questionnaire requests the following information from the contractor:
- The names, addresses, points of contact, and phone numbers for at least three suppliers the contractor does business with.
- A Financial Institution Reference Sheet, where the contractor provides permission for the government to obtain information about the contractor's accounts, including average monthly balances, loan amounts, and credit rating.
- A list of equipment the contractor plans to dedicate to the project, whether owned or rented.
The overall Solicitation FA665624B0002 is for a construction project to renovate and reconfigure an existing facility, including demolishing and rebuilding restrooms, walls, flooring, ceilings, HVAC, electrical, and other systems. The work is to be performed for the Department of the Air Force Reserve Command.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 24-0004 Request for Information.pdf | ||
| Site VIsit Attendees.pdf | ||
| Solicitation - FA665624B0002.pdf | ||
| A15 Attachment 6 Base Access requirements - bid opening.docx | DOCX document | |
| A16 Site visit AGENDA -ZQEL 24-0004 B302.docx | DOCX document | |
| Ammendment One.pdf | ||
| 24-0004 Specs Final 8 May 2024.pdf | ||
| A15 Attachment 6 Base Access requirements - site visit.docx | DOCX document | |
| A 15 Attachment 3 ZQEL 24-0004 Drawings.pdf | ||
| A 15 Attachment 2 Specification Manual ZQEL 24-0004.pdf | ||
| Solicitation - FA665624B0002.pdf | ||
| A15 Attachment 5 Question Submission Form.docx | DOCX document | |
| A15 Attachment 1 Wage Determination dated 5 April 2024.pdf | ||
| A15 Attachment 6 Base Access requirements - site visit.docx | DOCX document |
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Text version
ATTACHMENT 4
RESPONSIBILITY QUESTIONNAIRE
The following information is needed to help evaluate and determine your company responsible. Please complete the following items and submit with your proposal:
A. The names of at least three (3) suppliers that you do business with, to include points of contact and phone numbers.
I. Name of Supplier: _____________________________________________________
Address: ______________________________________________________________
Name of POC: _________________________________________________________
Telephone No: _________________________________________________________
II. Name of Supplier: ____________________________________________________
Address: ______________________________________________________________
Telephone No: _________________________________________________________
III. Name of Supplier: ___________________________________________________
Address: ______________________________________________________________
Telephone No: ________________________________________________
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: __________________________________________________________ Email: __________________________________________________________
INSTITUTION NAME: __________________________________________________________
POC name: __________________________________________________________________ POC title: _________________________________________________________________ POC phone number: ______________________ fax number: _______________________ Email: __________________________________________________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 910th Contracting Squadron, Youngstown ARS, Vienna OH.
| _____________________________________ | ________________________________ | |
| 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 |
LIST OF EQUIPMENT DEDICATED TO PROJECT
(Owned/Rented)
1.
2.
3.
4.
5.
FA665624B0001 Attachment 4
File details come from the government source that posted it. Updated .