Attachment 11 Financial Reference Worksheet.pdf
PDF 825 KB Posted
- Attached to
- Mess Attendant Services Federal contract opportunity
- Solicitation number
- FA483025Q0070
About this file
This document is a Financial Institution Reference Sheet (Attachment 11) for solicitation FA483025Q0070 issued by the 23D Contracting Squadron at Moody AFB, GA. The form is designed to be completed by potential contractors and their financial institutions as part of the contractor responsibility evaluation process.
The form requires contractors to provide permission for their banking institution to release financial information to the contracting squadron. The financial institution section is intended to be completed only if the contractor is selected as a potential awardee, and will capture details such as average account balances, loan amounts, lines of credit, payment history, and credit rating. The document includes blank sections for the contractor's company information and banking institution details, with instructions that this form will be sent to the contractor's bank for verification if they are a potential award recipient.
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Text version
FA483025Q0070
Attachment 11
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your quote 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:
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 23D Contracting Squadron, Moody AFB, GA.
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
| TO BE FILLED OUT BY CONTRACTOR: |
| TO BE FILLED OUT BY FINANCIAL INSTITUTION: |
| COMPANYS NAME: |
| Point of Contact POC Name: |
| POC Phone Number: |
| INSTITUTION NAME: |
| POC name: |
| POC title: |
| POC phone number: |
| fax number: |
| NameTitle: |
| 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 NSFs: |
| How long with this institution: |
| Credit rating with this institution: |
| I verify that the information provided above is current as of 1: |
| I verify that the information provided above is current as of 2: |
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