Attachment 04 Responsibility Questionnaire ZQEL 22-0006.docx
DOCX document 22 KB Posted
- Attached to
- ZQEL 22-0006 Renovate B301
- Solicitation number
- FA665626B0003
About this file
This is a Responsibility Questionnaire template required as part of the proposal submission for solicitation ZQEL 22-0006, a 100% HUBZone Small Business Set-Aside for the renovation of Building 301 at Youngstown Air Reserve Station. The document is not substantive contracting content but rather an appendix containing forms that offerors must complete to demonstrate contractor responsibility and financial capability.
The questionnaire requires submission of three supplier references with contact information, a financial institution reference sheet authorizing the government to verify the contractor's banking relationships and financial standing (including average account balances, loan amounts, lines of credit, payment history, and credit rating), and a list of equipment dedicated to the project whether owned or rented. The financial institution section is designed to be completed by the contractor's bank only if the firm is selected as the potential awardee, with the government sending the form directly to the financial institution for completion. This evaluation tool serves to assess the offeror's ability to perform the construction work and maintain financial responsibility throughout the project execution.
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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.
Attachment 4
File details come from the government source that posted it. Updated .