Attachment 2 Financial Worksheet.pdf
PDF 677 KB Posted
- Attached to
- Repair HVAC Bldg. 486
- Solicitation number
- FGWB250003
About this file
The document is a Financial Institution Reference Sheet (Attachment 2) for solicitation number FA670325B0002, designed to gather detailed financial information about a contractor's banking relationships. The form requires the contractor to provide details about their financial institutions and authorize the release of account information to the 94th Contracting Flight at Dobbins Air Reserve Base in Georgia. The financial institution is requested to complete a section detailing the contractor's average account balances, loans, lines of credit, payment history, and credit rating, with instructions to provide information in ranges rather than specific amounts.
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Text version
Attachment 2 FA670325B0002
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 institution/s in regards to a determination of contractor responsibility as part of the evaluation for solicitation number
FA670325B0002.
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 94th Contracting Flight, Dobbins ARB, GA.
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 _____________________________
Name/Title Signature/Date
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