Attachment 3 Financial Institution Reference Sheet.pdf
PDF 67 KB Posted
- Attached to
- Welcome Center Support Services Federal contract opportunity
- Solicitation number
- FA441725R0009
About this file
This is a Financial Institution Reference Sheet template (Attachment 3) for solicitation FA441725R0009, required as part of the contractor responsibility determination process by the 1st Special Operations Contracting Squadron at Hurlburt Field, FL.
The form consists of two main sections: one to be completed by the contractor providing company and banking institution details, and a second section to be completed only if selected as the potential awardee. The second section, to be filled out by the financial institution, requires information about the contractor's average monthly balances in checking and savings accounts, current loans, lines of credit, payment history (late payments/NSFs), length of relationship with the bank, and credit rating. The form requires amounts to be provided as ranges (e.g., low four figures, mid six figures) rather than specific values, and must be verified and signed by a bank representative.
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Text version
Attachment 3
FA441725R0009
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your offer 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 1st Special Operations Contracting Squadron, Hurlburt Field, FL.
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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