Attachment 5 - Financial Reference Sheet.docx

DOCX document 22 KB Posted

Attached to
Replace Munitions Storage Area Lighting Federal contract opportunity
Solicitation number
FA441720R0005
Issued by
Department of the Air Force Special Operations Command

About this file

This document includes an attachment and synopsis for a federal contract solicitation to replace munitions storage area lighting. The solicitation seeks to replace street and perimeter security lights at a munitions storage area at Hurlburt Field, Florida, and includes incidental related work. The contract is set aside for small businesses under NAICS code 238210 with a size standard of $16.5 million. The single award, firm-fixed price contract has a period of performance of 180 calendar days and an estimated value between $1 million to $2 million. Prospective contractors must register in the System for Award Management and submit bid bonds with proposals. Payment and performance bonds are due within ten days of award. The solicitation will be available on beta.SAM.gov and electronic proposal submission is anticipated. The Department of the Air Force Special Operations Command is the issuing agency.

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Text version

ATTACHMENT 5

FA441720R0005

Financial Reference Worksheet

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 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/TitleSignature/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/TitleSignature/Date

File details come from the government source that posted it. Updated .