Attachment 04 Responsibility Questionnaire ZQEL 24-0002.docx
DOCX document 22 KB Posted
- Attached to
- RUBBER REMOVAL ZQEL 24-0002
- Solicitation number
- FA665624B0005
About this file
This document is a Responsibility Questionnaire, which is a required attachment for a federal contract opportunity. The key details are:
The Responsibility Questionnaire requests information about the offeror's suppliers, financial institution references, and equipment dedicated to the project. Specifically, it asks for the names and contact information of at least three suppliers the offeror does business with, as well as permission for the government to obtain financial information from the offeror's banking institution. The offeror must also provide a list of equipment dedicated to the project. This information will be used to evaluate the offeror's responsibility as part of the award determination.
The federal contract opportunity is for rubber removal services on the Youngstown Air Reserve Station Assault Runway. It is a 100% HUBZone small business set-aside with a contract value between $25,000 and $100,000. The period of performance is 90 calendar days. The award will be a Firm-Fixed Price contract. The NAICS code is 237310 with a $45 million size standard.
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Other files
| File | Type | Posted |
|---|---|---|
| Agenda for Site Visit Rubber Removal.docx | DOCX document | |
| Bid Opening Base Access Requirements ZQEL 24-0002.docx | DOCX document | |
| Q and A.docx | DOCX document | |
| Attachment 06 Base Access Requirements ZQEL 24-0002.docx | DOCX document | |
| Attachment 07 Solicitation - FA665624B0005.pdf | ||
| Attachment 02 24-0002 Bid Specifications.pdf | ||
| Attachment 01 Wage Determination Davis-Bacon Act WD OH20240001.docx | DOCX document | |
| Attachment 05 Question Submission Form ZQEL 24-0002.docx | DOCX document | |
| Attachment 03 24-0002 -Full Set Plans Drawings.pdf |
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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 .