Attachment 4 Financial Questionnaire Sheet.docx
DOCX document 30 KB Posted
- Attached to
- Dome Maintenance Minot AFB
- Solicitation number
- FA452825QFH02
About this file
The document is a Financial Institution Reference Sheet for a federal solicitation (FA4528-25-Q-TA09) related to the Minot Air Force Base Dome Maintenance contract. The form requires contractors to provide detailed banking information, including permission for the 5th Contracting Squadron to verify financial standing. The form is designed to be completed in two stages: first by the contractor, who provides company and contact details, and then by the financial institution, which will disclose confidential financial information such as average monthly balances, loan amounts, lines of credit, payment history, and credit rating. The solicitation is issued by the Department of the Air Force Global Strike Command and pertains to preventative maintenance and repair services for an air-supported dome at Minot AFB, requiring contractors to supply personnel, equipment, tools, materials, transportation, and supervision for inspection and maintenance services.
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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 .