Attachment 4 - Financial Worksheet_Sample.pdf
PDF 155 KB Posted
- Attached to
- Construct and Repair Outfall 9 Culvert at Poorhouse Creek Federal contract opportunity
- Solicitation number
- FA670320B0002
About this file
This document contains a financial worksheet template and instructions for contractors to provide references from financial institutions for a federal construction project. The project is to eliminate accumulation of heavy debris at the Anti Terrorism structure upstream of Outfall 9 Culvert located at Dobbins Air Reserve Base in Georgia. Contractors are to fill out the financial worksheet with company information and have their financial institutions complete the institution details. Information requested from financial institutions includes average monthly balances, amount of any current loans or lines of credit, history of late or insufficient fund payments, length of relationship, and credit rating. The completed worksheet may be sent to financial institutions as part of the responsibility determination for solicitation number FA670320B0002 issued by the 94th Contracting Flight of the Department of the Air Force Reserve Command.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Solicitation Amendment FA670320B00020001 SF 30.pdf | ||
| PHC Attendance.pdf | ||
| Attachment 3 Wage Determination.pdf | ||
| Attachment 1 SPECIFICATIONS.pdf | ||
| Attachment 2 DRAWINGS.pdf | ||
| Solicitation - FA670320B0002.pdf | ||
| Attachment 5 Addendum - MOD (signed).pdf | ||
| Attach 6 -DOBBINS DD-1354 Template.pdf |
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Text version
Attachment 4 FA670320B0002
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Please fill out and return 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 solicitation number
FA670320B0002
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 94th Contracting Flight, Dobbins ARB, GA.
Printed Name/Title Signature/Date
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 of NSFs: ____________________________________ 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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