Attachment 6 - Financial.pdf
PDF 117 KB Posted
- Solicitation number
- FA4528-23-Q-BM03
About this file
This document contains a financial institution reference sheet template and details of a solicitation for elevator maintenance, repair, and inspection services at Minot Air Force Base in North Dakota. The 5-year contract will provide all management, tools, supplies, equipment, parts, and labor necessary to maintain, repair, and inspect the real property vertical transportation equipment, including freight and passenger elevators, wheelchair/stair lifts, dock levelers, and dumbwaiters. Contractors must include a completed reference sheet from each financial institution where they hold business accounts as part of their proposal package. The sheet requests information on average monthly balances, current loans and lines of credit, payment history, account duration, and credit ratings to aid the contracting office's responsibility determination.
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Attachment 6
FA4528-23-Q-BM03
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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