Attachment 04 Responsibility Questionnaire ZQEL 26-0010.docx
DOCX document 22 KB Posted
- Solicitation number
- FA665626R0006
About this file
This is a Responsibility Questionnaire attachment that establishes evaluation criteria for contractor responsibility on solicitation FA665626R0006 for repair work to the Aircraft Fire Training Facility (AFTF) aircraft mock-up at Youngstown Air Reserve Station.
The document requires prospective contractors to submit three supplier references with complete contact information, demonstrating established business relationships and supply chain reliability. Contractors must also provide a Financial Institution Reference Sheet authorizing the 910th Contracting Squadron 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 dedicated to the project, whether owned or rented, in support of their capacity to perform the repair and corrective work. The questionnaire is designed to evaluate contractor financial capability, business reputation, and resource availability as factors in determining overall responsibility for award on this Air Force Reserve Command solicitation.
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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 .