Attachment 6 - Financial Worksheet.docx
DOCX document 27 KB Posted
- Attached to
- Hurlburt Field HVAC MACC Federal contract opportunity
- Solicitation number
- FA441725R0017
About this file
Attachment 6 is a Financial Reference Worksheet for the Hurlburt Field HVAC MACC solicitation (FA441725R0017). The document is a template for contractors to provide financial institution references, with sections to be completed by both the contractor and their financial institution. The form requires details such as average monthly account balances, loan amounts, lines of credit, payment history, and credit rating.
The worksheet is part of a Total Small Business Set Aside procurement for an Indefinite-Delivery, Indefinite-Quantity (IDIQ) HVAC contract with the Department of the Air Force Special Operations Command. Contractors must be registered in NAICS code 238220 with a size standard of $19M, have an office within 300 miles of Hurlburt Field, FL, and possess a minimum bonding of $1,000 (single)/$5,000,000 (aggregate). The contract will have a five-year ordering period, with task orders ranging from $1,000 to $3,000,000, and a total contract ceiling of $5,000,000 per contractor, with a combined ceiling of $25,000,000 for approximately five selected contractors.
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Text version
ATTACHMENT 6
FA441725R0017
Financial Reference Worksheet
FINANCIAL INSTITUTION REFERENCE SHEET
14 Nov 2024 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: ______________________ email: _______________________
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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