Attachment 3 Financial Worksheet.pdf
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- Solicitation number
- FA670325B0001
About this file
Attachment 3 is a Financial Institution Reference Sheet for a federal contract opportunity (Solicitation Number FA670325B0001) related to underground conduit installation for telecommunications systems. The form requires contractors to provide detailed financial information from their banking institutions, including average monthly account balances, loan amounts, lines of credit, payment history, and credit ratings. The document is designed to help the 94th Contracting Flight at Dobbins Air Reserve Base evaluate a contractor's financial responsibility as part of the solicitation process. The form must be completed by both the contractor and the financial institution, with the contractor granting permission for the bank to release account information to government representatives.
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Attachment 3 FA670325B0001
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
FA670325B0001.
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
File details come from the government source that posted it. Updated .