Attachment 3 - Financial Institution Reference Sheet.pdf
PDF 113 KB Posted
- Attached to
- Minot AFB FY21 COCESS Federal contract opportunity
- Solicitation number
- FA452821R0001
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment 1 - Solicitation Amendment FA452821R00010001.pdf | ||
| Amendment 1 - Attachment 1 - Statement of Work Amendment 1.pdf | ||
| Amendment 1 - Attachment 8 - Commom COCESS Items Price List - Market Basket Amendment 1.xls | XLS spreadsheet | |
| Amendment 1 - Attachment 10 - COCESS 2020 Sales.xlsx | XLSX spreadsheet | |
| Amendment 1 - Attachment 11 - COCESS Q and A.pdf | ||
| Attachment 1 - Statement of Work.pdf | ||
| Attachment 6 - Subcontractor Consent.docx | DOCX document | |
| Attachment 7 - Pricing Discount Coefficient Table.xlsx | XLSX spreadsheet | |
| Attachment 8 - Commom COCESS Items Price List - Market Basket.xlsx | XLSX spreadsheet | |
| Attachment 9 - Requested Store Stock Items.xlsx | XLSX spreadsheet | |
| Solicitation - FA452821R0001.pdf | ||
| List of Attachments.pdf | ||
| Attachment 4 - Section L - 52.212-1 Addendum.pdf | ||
| Attachment 2 - Past Performance Information Form.pdf | ||
| Attachment 5 - Section M - 52.212-2 Addendum.pdf |
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Text version
FA452821R0001
Attachment 3
Financial Institution Reference Sheet
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: 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 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 email address:____________________________________________________________
POC title: ____________________________________________________________________
POC phone number: ______________________ fax number: ___________________________
Account #_______________________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 5th Contracting Squadron, Minot AFB, North Dakota.
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
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