Attachment 13 - Proof of Financial Responsibility.pdf

GENERAL FINANCIAL INFORMATION

The following information is requested to aid the Government in determining your financial responsibility. If your answer to any question is “Not Applicable” indicate as such.

1. Central Contractor Registration Information:

a) Date Enrolled:__________________________________________________________________

b) Expiration Date:________________________________________________________________

c) DUNS:________________________________________________________________________

d) CAGE:________________________________________________________________________

2. Offeror Point of Contact Information:

a) Name:_________________________________________________________________________

b) Position Held:___________________________________________________________________

c) Telephone:_____________________________________________________________________

d) Email:_________________________________________________________________________

3. Company is a separate entity ( ) division ( ). If a division or subsidiary, please provide name of parent company:_______________________________________________________________________

4. Financial Information:

a) Name of Bank:__________________________________________________________________

b) MailingAddress:_________________________________________________________________

c) Point of Contact:________________________________________________________________

d) Work email/telephone:____________________________________________________________

5. Do you have the equipment needed to perform the contract on which you are submitting a proposal or do you have the resources to obtain the equipment? Yes ( ) No ( )

Typed Name of Preparer Signature Date

FA4819-21-R-0002

TYNDALL AFB, FL

ATTACHMENT 10

GENERAL FINANCIAL INFORMATION