Attachment 4 - Financial Questionnaire Sheet.pdf
PDF 223 KB Posted
- Attached to
- Front Desk Data Entry - Minot AFB
- Solicitation number
- FA452826RFQTB02
About this file
This document is a Responsibility Questionnaire and Financial Institution Reference Sheet attachment to federal contract solicitation FA4528-25-Q-TA02 issued by the 5th Contracting Squadron at Minot Air Force Base, North Dakota.
The Responsibility Questionnaire requires proposing contractors to submit information on up to three (3) previous customers or contracts to demonstrate company capability and track record. For each reference, contractors must provide the customer/contract name, address, point of contact name and phone number, dates and years of performance, annual dollar value, and a description of services performed with additional comments. This information is used to evaluate contractor responsibility for contract award consideration.
The Financial Institution Reference Sheet requires contractors to identify each financial institution where the company maintains business accounts and provide their point of contact information. Contractors complete their company name, POC name and phone number, and the institution details (name, POC name, title, and contact information), along with written permission to release account information. If selected as the potential awardee, the government will send this form directly to the contractor's banking institution(s) to complete the financial section, which requests information provided as ranges including average monthly checking and savings balances, current loans, lines of credit, payment history, duration of relationship, and credit rating. The financial institution section is not completed by the contractor but only by the bank upon government request following selection as a potential awardee.
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Other files
| File | Type | Posted |
|---|---|---|
| FY 26 - Front Desk Admin - Question Answers (002).docx | DOCX document | |
| Front Desk Admin Support - Combined Synopsis and Solicitation.pdf | ||
| Front Desk Admin Support - Combined Synopsis and Solicitation.pdf | ||
| MFRC Front Desk Admin PWS.pdf | ||
| Quote Sheet - Front Desk Admin Support.xlsx | XLSX spreadsheet |
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Text version
FA4528-26-TB02
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: ___________________________________
1558054260A Inserted Text
FA4528-25-Q-TA02
III. Name of Customer/Contract:___________________________________________
Address: ______________________________________________________________
Name of POC: _________________________________________________________
Telephone No: ________________________________________________
Dates/Years of Performance: ______________________________________________
Annual $ Value: ________________________________________________________
Services Performed/Additional Comments: ___________________________________
FA4528-25-Q-TA02
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 .