A15 Attachment 4 Responsibility Questionnaire sidewalks.docx
DOCX document 17 KB Posted
- Attached to
- Repair Various Sidewalks, Ramps, and Steps Federal contract opportunity
- Solicitation number
- FA665620B0002
About this file
This solicitation package describes a federal construction contract opportunity. The contract is for repair and construction work on various sidewalks, ramps, and steps at the 910th Air Wing of the Youngstown Air Reserve Station in Vienna, Ohio. Work includes installing handrails, constructing and replacing concrete steps and sidewalks, modifying a building door for handicap accessibility, and constructing a concrete handicap ramp. The solicitation is designated as a 100% HUBZone small business set-aside with an estimated value between $100,000 and $250,000. The contract performance period is 60 calendar days from notice to proceed. The Department of the Air Force Reserve Command is the contracting agency. Interested parties can access solicitation documents on SAM.gov beginning June 3, 2020 and must submit offers by July 7, 2020.
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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 and the 911th Contracting Squadron, Pittsburgh ARS, Coraopolis, PA.
| _____________________________________ | ________________________________ | |
| 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.
FA665620B0002 Attachment 4
File details come from the government source that posted it. Updated .