Attachment 4 - Financial Reference.docx
DOCX document 16 KB Posted
- Attached to
- Flooring IDIQ Federal contract opportunity
- Solicitation number
- FA706022R00
- Issued by
- Department of the Air Force
About this file
This document contains a financial reference sheet template and instructions for contractors to provide with proposals for solicitation number FA706022R0031. The solicitation is for a flooring indefinite-delivery, indefinite-quantity (IDIQ) contract issued by the Department of the Air Force. Contractors are required to submit a completed reference sheet from each financial institution where they hold business accounts, authorizing the institution to provide account details including average monthly balances, loans, lines of credit, late payments or non-sufficient funds records, and credit ratings to the 11th Contracting Squadron at Joint Base Anacostia-Bolling for responsibility determinations as part of the evaluation and award process. The financial reference sheet requests this information as numeric ranges to protect sensitive details.
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Text version
FA706022R0031
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 |
File details come from the government source that posted it. Updated .