Attachment 5 - Financial Reference Sheet 6.2.2023.docx
DOCX document 27 KB Posted
- Attached to
- ADD/ALTER Space Deficiencies, 8 SOS, Bldg 90145
- Solicitation number
- FA441723R0002
About this file
This document contains an attachment and description for a federal contract solicitation. The solicitation is for minor demolition and new construction work for an addition to Building 90145 at Hurlburt Field, Florida for the 8th Special Operations Squadron. The work includes constructing a one-story slab-on-grade addition with scored, split-face low and end walls to match the existing building. Interior renovations to the existing building are limited to removing and replacing ceiling grid and tiles. Exterior work involves demolishing an existing covered canopy, remodeling stormwater lines and the drive/parking area on the east side, and adding sidewalks. The project also includes new mechanical, fire protection and electrical systems connecting to or fed from the existing adjacent building. The solicitation is issued by the Department of the Air Force Special Operations Command.
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Text version
ATTACHMENT 5
FA441723R0002
Financial Reference Worksheet
FINANCIAL INSTITUTION REFERENCE SHEET
2 Jun 2023
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 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 |
File details come from the government source that posted it. Updated .