Attach 4 - Financial_Repair B510 HVAC_4.pdf
PDF 82 KB Posted
- Attached to
- Repair Building 510 HVAC
- Solicitation number
- FA670326Q0002
About this file
This is a Financial Institution Reference Sheet template for federal contract evaluation purposes. The form is designated as Attachment 4 to solicitation FA6703-26-Q-0002 for Repair B 510 HVAC at Dobbins Air Reserve Base, Georgia, issued by the 94th Contracting Flight.
The document requires contractors to submit one reference sheet for each business financial institution with which they maintain accounts. The contractor section requests company name, point of contact information, and authorization for release of financial data. The financial institution section, to be completed by the bank or credit union, requests account balance information provided as ranges (low four figures, mid six figures, etc.), current loan amounts, lines of credit, history of late payments or non-sufficient funds (NSFs), duration of the banking relationship, and credit rating assessment. The financial institution must verify that all information provided is current as of a specified date. This form is used as part of the contractor responsibility determination during the evaluation process for the HVAC repair solicitation.
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Text version
FA670326Q0002 Attach 4
FINANCIAL INSTITUTION 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 institution/s in regards to a determination of contractor responsibility as part of the evaluation for solicitation number FA6703-26-Q-0002, Repair B 510 HVAC, Dobbins ARB, GA.
TO BE FILLED OUT BY CONTRACTOR:
Company’s Name:
Point of Contact (POC) Name:
POC Phone Number:
INSTITUTION NAME:
POC Name:
POC 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 94th Contracting Flight, Dobbins ARB, GA.
Printed 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
File details come from the government source that posted it. Updated .