Attachment 13 - Financial Institution Reference Sheet .pdf

Solicitation No.: FA446025R0002

Source Selection Information -- See FAR 2.101 and 3.104

Financial Institution Reference Sheet

FINANCIAL INSTITUTION REFERENCE SHEET

Instructions to Offeror: 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 regard 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 email address:

POC phone number: fax number:

I give permission for the following information regarding my account/s at your institution to be released to Jennifer A. Bradford and/or Arthur J. Brown of the 19th Contracting Squadron, Little Rock AFB, Arkansas.

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

Attachment 13

Source Selection Information -- See FAR 2.101 and 3.104