Attachment 04 Responsibility Questionnaire ZQEL 26-0001.docx
DOCX document 23 KB Posted
- Attached to
- Renovate B203 for C130 J Conversion
- Solicitation number
- FA665626B0005
About this file
This is a Responsibility Questionnaire attachment designed to evaluate contractor capability and financial stability for the solicitation FA665626B0005 (Renovate B203 for C130J Conversion) issued by the 910th Contracting Squadron at Youngstown Air Reserve Station in Vienna, Ohio.
The questionnaire requires responding contractors to submit three supplier references with complete contact information, demonstrating established business relationships and supply chain capability. Contractors must also provide a Financial Institution Reference Sheet authorizing the government to contact their banking institutions to verify financial stability, including average monthly balances in checking and savings accounts, current loan amounts, lines of credit, payment history, length of banking relationship, and credit rating. Additionally, contractors must list equipment (owned or rented) that will be dedicated to the project. The financial institution section includes instructions that the form will only be sent to banks if the contractor is selected as the potential awardee. This questionnaire serves as part of the overall evaluation criteria to determine contractor responsibility prior to contract award for the building 203 renovation project supporting C-130J aircraft engine and propeller maintenance operations.
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Other files
| File | Type | Posted |
|---|---|---|
| Additional RFI 22 Sep 26.docx | DOCX document | |
| Solicitation Amendment FA665626B00050001 SF 30.pdf | ||
| RFI FA665626B0005.docx | DOCX document | |
| Site Visit Agenda and Attendees B203.pdf | ||
| Drawings B203 27 July 26.pdf | ||
| Solicitation - FA665626B0005.pdf | ||
| Attachment 03 Project ZQEL 24-0006 Statement of Work.pdf | ||
| Attachment 06 Base Access Requirements ZQEL 26-0001.docx | DOCX document | |
| Attachment 05 Question Submission Form ZQEL 26-0001.docx | DOCX document | |
| Attachment 02 Project ZQEL 24-0006 Specifications.pdf | ||
| Attachment 01 Wage Determination.txt | TXT text file |
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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
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