Attachment 7-Financial_Information_Request_Contractor.pdf

DEPARTMENT OF THE AIR FORCE

UNITED STATES SPACE FORCE

45TH SPACE WING

Date

MEMORANDUM FOR WHOM IT MAY CONCERN

FROM: 45 CONS/PKA

1201 Edward H White II St.

Patrick AFB, FL 32925-3299

SUBJECT: Financial Information Request and Release Authorization

Reference: Solicitation FA252120R0009, Space Coast Multiple Award Construction Contract

(SCMACC)

1. Our office is evaluating:

Contractor

Address

City State Zip Code for possible award of referenced contract. In order to proceed, we must verify the contractor's financial capability. The firm has provided your name as their bank reference and granted you permission to release the requested information, as indicated below, to provide to the Government.

2. Please complete the attached questionnaire and return it by email to kimberly.horner@us.af.mil and sandra.seman@us.af.mil at your earliest convenience, but no later than seven (7) calendar days after receipt of this request.

3. All information provided will be treated as FOR OFFICIAL USE ONLY and will not be publicly released. If you need any other information or have any questions, please call me at (321) 494-0447.

Thank you very much for your assistance.

KIMBERLY S. HORNER

Contracting Officer

Attachment:

Financial Information Sheet mailto:keith.dastur.1@us.af.mil

1st ind, (Name of Contractor) (Date)

TO:

(Name of Financial Institution) (Phone)

I hereby authorize the financial institution to release my information as requested.

Signature:

By:

(Print name/title of contractor authorized representative)

Attachment 7 - Financial Information Request Space Coast Multiple Award Construction Contract

(SCMACC) RFP # FFA252120R0009

1. Name of Contractor to whom the following information is applicable:

2. Name of Financial Institution:

3. Address of Financial Institution:

City State Zip Code

4. Point of Contact (POC) for Financial Institution:

5. Phone Number for POC:

6. Email Address of POC:

7. How long has the firm been a commercial customer of your institution? (Years) (Months)

8. Type of Account, the current balances, and the six (6) month average balance maintained for each account:

Current 6-Month Average

Checking $ Checking $

Savings $ Savings $

CD $ CD $

Money Market $ Money Market $

Other $ Other $

9. Does the contractor maintain a loan balance at the bank? If so, what is the amount?

Yes $ No

10. Does the contractor maintain an unsecured line of credit at the bank? If so, what is the amount?

Yes $ No

11. What is the contractor's current standing with your bank?

Outstanding Excellent Satisfactory Poor Unsatisfactory Other (explain below)

Comments:

I certify that the above information is correct and current as of:

Date

Signature