Attachment 5 - Financial Worksheet.pdf
PDF 358 KB Posted
- Attached to
- MSA Lightning Protection System Repair Federal contract opportunity
- Solicitation number
- FA441721R0007
About this file
This document contains a financial reference worksheet for a federal contract solicitation to repair lightning protection systems. The contractor shall furnish all labor, materials, tools and equipment to repair the lightning protection systems at the Munitions Storage Area at Hurlburt Field, Florida in accordance with provided drawings and specifications. The projected period of performance is 180 calendar days from notice to proceed. The financial reference worksheet requests average monthly balances and credit information from financial institutions and authorizes the release of this information to the 1st Special Operations Contracting Squadron for responsibility determinations as part of the solicitation evaluation and award.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| FA441721R0007 Questions and Answers - Repair MSA Lightning Protection System 4 Feb 2021.pdf | ||
| Pre-Proposal Site Visit Memo FA441721R0007 Repair MSA Lightning Protection System.pdf | ||
| 21R0007 Site Visit Sign-in Sheet_Redacted.pdf | ||
| Solicitation - FA441721R0007.pdf | ||
| Attachment 3 - Wage Determination FL20210217 - 1 Jan 2021.pdf | ||
| Attachment 4 - PPQ.pdf | ||
| Attachment 1 - CP1038321 SPECIFICATIONS_FINAL.pdf | ||
| Attachment 2 - CP1038321 DESIGN DRAWINGS_FINAL.pdf | ||
| Attachment 6 - 50 Division Construction Cost Estimate Worksheet.xls | XLS spreadsheet |
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Text version
ATTACHMENT 5
FA441721R0007
Financial Reference Worksheet
FINANCIAL INSTITUTION REFERENCE SHEET
14 Jan 2021
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
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