Attachment 4-Responsibility Questionnaire.docx
DOCX document 20 KB Posted
- Attached to
- Shortfield Striping and Rubber Removal
- Solicitation number
- FA665625B0001
About this file
The file is a Responsibility Questionnaire for a federal contract opportunity related to runway maintenance at Youngstown Air Reserve Station. The document requires potential contractors to provide detailed information to demonstrate their business capability, including:
- Supplier references (three required) with contact information
- Financial institution references, with a form to be completed by the contractor's bank detailing account information such as average monthly balances, loans, lines of credit, and credit rating
- A section for listing equipment dedicated to the project
The associated federal contract opportunity involves shortfield striping and rubber removal at Youngstown ARS, specifically requiring the removal of 95% of rubber buildup from a designated runway area without damaging pavement surfaces. The project includes repainting LZ markings, Controlled and Non-Controlled Apron Markings according to specifications, and will be conducted under the Department of the Air Force Reserve Command's solicitation number FA665625B0001.
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Other files
| File | Type | Posted |
|---|---|---|
| Bid Opening-Base Access requirements.docx | DOCX document | |
| Questions and Answers FA665625B0001.docx | DOCX document | |
| Site visit Agenda.docx | DOCX document | |
| Solicitation Amendment FA665625B00010002 SF 30.pdf | ||
| Attachment 2-00 00 25-0001 Bid Specifications.pdf | ||
| Attachment 3-25-0001 FULL SET.pdf | ||
| Attachment 5-Question Submission Form.docx | DOCX document | |
| Solicitation Amendment FA665625B00010001 SF 30.pdf | ||
| Attachment 6-Base Access requirements - site visit.docx | DOCX document | |
| Attachment 1-Wage Determination.txt | TXT text file | |
| Solicitation - FA665625B0001.pdf |
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Text version
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 at least three (3) suppliers that you do business with, to include points of contact and phone numbers.
I. Name of Supplier: _____________________________________________________
Address: ______________________________________________________________
Name of POC: _________________________________________________________
Telephone No: _________________________________________________________
II. Name of Supplier: ____________________________________________________
Address: ______________________________________________________________
Telephone No: _________________________________________________________
III. Name of Supplier: ___________________________________________________
Address: ______________________________________________________________
Telephone No: ________________________________________________
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: __________________________________________________________ Email: __________________________________________________________
INSTITUTION NAME: __________________________________________________________
POC name: __________________________________________________________________ POC title: _________________________________________________________________ POC phone number: ______________________ fax number: _______________________ Email: __________________________________________________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 910th Contracting Squadron, Youngstown ARS, Vienna OH.
| _____________________________________ | ________________________________ | |
| 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 |
LIST OF EQUIPMENT DEDICATED TO PROJECT
(Owned/Rented)
1.
2.
3.
4.
5.
FA665624B0001 Attachment 4
File details come from the government source that posted it. Updated .