Attachment 3 - Financial Institution Reference Sheet.pdf
PDF 365 KB Posted
- Attached to
- Grounds Maintenance Services Federal contract opportunity
- Solicitation number
- FA465925Q0002
About this file
The document is a Financial Institution Reference Sheet for a Grounds Maintenance Services contract (Solicitation Number FA465925Q0002) at Grand Forks AFB, North Dakota. The form requires contractors to have financial institutions complete a detailed reference sheet to help determine contractor responsibility during the source selection process. Contractors must provide permission for their financial information to be released to the 319th Contracting Squadron and have the completed form submitted directly to Jeremiah Snedker via email by the solicitation closing date.
The financial institution is asked to provide specific details including average monthly balances in checking and savings accounts, current loan and line of credit amounts, payment history, duration of the banking relationship, and credit rating. The form is designed to assess the financial stability and reliability of potential contractors for the grounds maintenance services contract, which involves maintaining grounds, irrigation systems, tree care, and snow/ice removal at Grand Forks Air Force Base for the Department of the Air Force Air Mobility Command.
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Text version
Source Selection Information -- See FAR 2.101 and 3.104 – FOR OFFICIAL USE ONLY
Source Selection Information -- See FAR 2.101 and 3.104 – FOR OFFICIAL USE ONLY
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 institutions in regards to a determination of contractor responsibility as part of the evaluation of soliciting/awarding a new contract for Grounds Maintenance Services at Grand Forks AFB, ND. The top portion should be completed first, then sent to each financial institution for completion. Please have completed surveys returned directly from the financial institutions to Jeremiah Snedker via email at jeremiah.snedker@us.af.mil by the solicitation closing date.
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 319th Contracting Squadron, Grand Forks AFB ND.
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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