Attachment 07 Financial Worksheet.pdf

Name/Title Signature/Date

Source Selection Information -- See FAR 2.101 and 3.104

Source Selection Information -- See FAR 2.101 and 3.104

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 institutions in regards to a determination of contractor responsibility as part of the evaluation of soliciting/awarding a Grounds Maintenance at Eielson AFB Alaska. The top portion should be completed first, then sent to each financial institution for completion.

Please have completed surveys returned directly from the financial institutions to via email at_tara.richmond@us.af.mil by the solicitation closing date.

TO BE FILLED OUT BY CONTRACTOR:

Company’s Name:

Point of Contact (POC) Name:

POC Phone Number:

Mrs. Tara Richmond

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 354th Contracting Squadron, Eielson AFB AK.

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 mailto:_tara.richmond@us.af.mil%20by%20the%20solicitation%20closing%20date.