Attachment 4 - Financial Reference.docx
DOCX document 16 KB Posted
- Attached to
- Multiple Award Handyman IDIQ Federal contract opportunity
- Solicitation number
- FA706022R0032
- Issued by
- Department of the Air Force
About this file
This document contains a financial reference sheet template and instructions for contractors to submit with proposals for solicitation number FA706022R0032. The solicitation is for a multiple award handyman indefinite delivery, indefinite quantity contract to be awarded by the Department of the Air Force. Contractors are required to provide financial institution references, including average monthly balances, current loans and lines of credit, and credit history. The financial reference sheet requests permission to release this information and verification by the financial institution. It collects contractor and banking point of contact information for evaluation purposes.
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Text version
FA706022R0032
Attachment 4
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 email address:____________________________________________________________ POC title: ____________________________________________________________________ POC phone number: ______________________ fax number: ___________________________ Account #_______________________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 11th Contracting Squadron, Joint Base Anacostia-Bolling, DC.
| _____________________________________ | _____________________________________ | |
| 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 |
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