Att3_Financial Institution Reference Sheet.pdf

Source Selection Information -- See FAR 2.101 and 3.104 – FOR OFFICIAL USE ONLY

Source Selection Information -- See FAR 2.101 and 3.104 – FOR OFFICIAL USE ONLY

7. FINANCIAL INSTITUITION REFERENCE SHEET

Instructions to Contractor: Please fill out and return a reference sheet for each financial institution that you have a business account with. This sheet may be sent to the banking institutions in regards to a determination of contractor responsibility as part of the evaluation for the solicitation: FA465921R0001, for Protective Coatings Maintenance Services at Grand Forks AFB, ND. The top portion should be completed first, then sent to each financial institution for completion. Please have completed surveys returned directly from the financial institutions to Mr. Ja’Haun Stafford via email at jahaun.stafford.2@us.af.mil contract.

TO BE FILLED OUT BY CONTRACTOR:

COMPANY’S NAME:

Point of Contact (POC) Name: POC

Phone Number:

INSTITUTION NAME:

POC name:

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 319th Contracting Squadron, Grand Forks AFB, and North Dakota.

Name/Title Signature/Date

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 of NSFs:

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

Fax or Email Reference Sheet to Mr. Ja’Haun Stafford, jahaun.stafford.2@us.af.mil Contract Specialist Fax: 701-747-4215