Attachment 4 - Financial Questionnaire Sheet.pdf
PDF 316 KB Posted
- Attached to
- BUS SERVICES MINOT AFB (Q/A Updated with extension and new Wage Determination) Extended to July 2nd
- Solicitation number
- FA452825-Q-TA02
- Issued by
-
Department of the Air Force
About this file
This document is a Responsibility Questionnaire and Financial Institution Reference Sheet for a federal contract opportunity for school bus services at Minot Air Force Base. The document requires potential contractors to provide detailed information about their business, including:
- Customer/Contract References: Contractors must list up to three previous customers/contracts, including contact information, dates of performance, annual dollar value, and services performed. 2. Financial Institution Information: Contractors are required to submit a reference sheet for each business banking account, with sections to be completed by both the contractor and the financial institution. The form requests details such as average account balances, loan amounts, lines of credit, payment history, and credit rating. This documentation is part of the evaluation process for determining contractor responsibility for the school bus service solicitation, which involves transporting approximately 700 children in grades K-8 at Minot AFB from November to April.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 6- SCA Wage Determination Rev 1 2025WD NEW.pdf | ||
| Cropped Dakota Map.png | PNG image | |
| Dakota Elem 2024 25 Route Stop times.xlsx | XLSX spreadsheet | |
| Cropped North Plains Map.png | PNG image | |
| Cropped Memorial Map.png | PNG image | |
| Questions with Answers BUS Services 2025.pdf | ||
| Memorial 2024 25 RouteStop times.xlsx | XLSX spreadsheet | |
| North Plains 2024 25 Route Stop times.xlsx | XLSX spreadsheet | |
| Attachment 5 - Past Performance.pdf | ||
| Attachment 3 - 2025 BUS Quote Sheet.xlsx | XLSX spreadsheet | |
| Attachment 6-SCA Wage Determination 24.pdf | ||
| Attachment 7 - QASP.pdf | ||
| Attachment 1- BUS Minot AFB Combo May 2025.pdf | ||
| Attachment 2 - 2025 School Bus PWS .pdf |
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Text version
FA4528-25-Q-TA02
Attachment 4
RESPONSIBILITY QUESTIONNAIRE
The following information is needed to help evaluate and determine your company responsible. Please complete the following items and submit with your proposal:
A. The names of up to three (3) customers/contracts that you have held or done business with, to include points of contact and phone numbers.
I. Name of Customer/Contract:_____________________________________________
Address: ______________________________________________________________
Name of POC: _________________________________________________________
Telephone No: _________________________________________________________
Dates/Years of Performance: ______________________________________________
Annual $ Value: ________________________________________________________
Services Performed/Additional Comments: ___________________________________
II. Name of Customer/Contract:____________________________________________
Address: ______________________________________________________________
Name of POC: _________________________________________________________
Telephone No: _________________________________________________________
Dates/Years of Performance: ______________________________________________
Annual $ Value: ________________________________________________________
Services Performed/Additional Comments: ___________________________________
III. Name of Customer/Contract:___________________________________________
Address: ______________________________________________________________
Name of POC: _________________________________________________________
Telephone No: ________________________________________________
Dates/Years of Performance: ______________________________________________
Annual $ Value: ________________________________________________________
Services Performed/Additional Comments: ___________________________________
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 5 th
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 .