Attachment 5 - Financial Institution Reference Sheet.pdf
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- Solicitation number
- FA441720Q0021
About this file
This document contains a financial institution reference sheet template to be completed by contractors bidding on a solicitation from the Department of the Air Force Special Operations Command. The solicitation is for grease traps, sewage lift stations, and holding tanks maintenance services at Hurlburt Field Air Force Base. Contractors must include a completed reference sheet from each financial institution they have a business account with as part of the proposal package. The sheet requests information on account balances, loans, lines of credit, payment history, and credit ratings to aid the contracting office's responsibility determination for award. Questions on the solicitation are due by August 13th, 2020 and proposals will close on August 24th, 2020.
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Text version
Attachment 5
FA441720Q0021
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your offer 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 1st Special Operations Contracting Squadron, Hurlburt Field, FL.
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
| TO BE FILLED OUT BY CONTRACTOR: |
| TO BE FILLED OUT BY FINANCIAL INSTITUTION: |
| COMPANYS NAME: |
| Point of Contact POC Name: |
| POC Phone Number: |
| INSTITUTION NAME: |
| POC name: |
| POC title: |
| POC phone number: |
| fax number: |
| NameTitle: |
| 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 NSFs: |
| How long with this institution: |
| Credit rating with this institution: |
| I verify that the information provided above is current as of 1: |
| I verify that the information provided above is current as of 2: |
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