Attachment 3 - Financial Reference Sheet - FA441725R0012.pdf
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- Attached to
- Mess Attendant Federal contract opportunity
- Solicitation number
- FA441725R0012
About this file
Attachment 3 is a Financial Institution Reference Sheet for solicitation FA441725R0012, designed to provide financial background information on potential contractors. The form requires contractors to list their business accounts and obtain permission to release account details to the 1st Special Operations Contracting Squadron at Hurlburt Field, FL. If selected as a potential awardee, the contractor's financial institution will be asked to complete the second section, which includes details such as average monthly account balances, loan amounts, lines of credit, payment history, and credit rating.
This reference sheet is part of the solicitation for mess attendant services supporting two food operations at Hurlburt Field, Florida. The anticipated contract is a Firm Fixed Price type under NAICS code 722310, with a small business size standard of $47.0 million. Contractors must be registered in the System for Award Management (SAM) to be eligible, and the contract will be managed by Air Force personnel from the 1st Special Operations Force Support Squadron, who will retain all management responsibilities and decision-making authority.
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Text version
FA441725R0012
Attachment 3
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 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
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