Attachment 4 Financial.docx
DOCX document 30 KB Posted
- Attached to
- Dome Maintenance Minot AFB
- Solicitation number
- FA452825QTA09
- Issued by
-
Department of the Air Force
About this file
Attachment 4 is a Financial Institution Reference Sheet for Solicitation FA452825QTA09 for Dome Maintenance at Minot AFB. The document is a template requiring contractors to provide detailed financial information from their banking institutions. The form requires contractors to disclose their company details, banking institution contact information, and grant permission for the 5th Contracting Squadron to verify financial standing.
The form is designed to assess contractor financial responsibility and includes sections to be completed by both the contractor and their financial institution. Required information includes average monthly account balances, current loans, lines of credit, payment history, credit rating, and institutional relationship duration. This financial reference sheet will be used as part of the evaluation process for determining contractor eligibility for the Air Force's Air-Supported Dome maintenance and repair service contract.
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Text version
FA4528-25-Q-TA09
Attachment
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: ________________ Account Number: ___________________
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__________________
File details come from the government source that posted it. Updated .