Attachment 6 - Financial.docx
DOCX document 17 KB Posted
- Attached to
- Base Telecommunication Services (BTS) - Minot AFB, ND Federal contract opportunity
- Solicitation number
- FA4528-24-Q-KM03
About this file
This document contains a financial institution reference sheet template and information about a federal contract opportunity for base telecommunication services at Minot Air Force Base in North Dakota. The financial institution reference sheet is to be included with proposals and allows the contractor to provide permission for their financial institution to disclose information to the Air Force such as average account balances, loans, lines of credit, payment history and credit ratings. The related federal contract opportunity is solicitation number FA4528-24-Q-KM03 seeking proposals for base telecommunication services at Minot AFB, which is issued by the Department of the Air Force Global Strike Command. The solicitation involves products and services necessary to support telecommunications requirements at the Air Force base.
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Text version
FA4528-24-Q-KM03
Attachment 6
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: ________________ Account Number: ___________________
I give permission for the following information regarding my account(s) at your institution to be released to representatives of the 5th Contracting Squadron, Minot AFB, North Dakota.
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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