Attachment 7 - Financial Information Request.pdf

MEMORANDUM FOR WHOM IT MAY CONCERN

FROM: 2 CONS/PKB

801 Kenney Ave., Suite 2300 Barksdale AFB, LA 71110

SUBJECT: Financial Information Request and Release Authorization

REFERENCES: (a) Solicitation FA460822R0001

1. Our office is evaluating

(NAME OF FIRM)

of

(FIRM’S ADDRESS, INCLUDING CITY, STATE, AND 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 release, as indicated below, to provide it to the government.

2. Please complete the attached questionnaire and return it by email marco.pirozzoli.1@us.af.mil and christopher.mitchell.36@us.af.mil at your earliest convenience, but not later than seven (7) calendar days after receipt of this request or by the proposal due date.

3. All information provided will be FOR OFFICIAL USE ONLY and will not be publicly released. If you need any other information or have any questions, please call Christopher Mitchell at 318-456-6739 or Marla Poirier at 318-456-6940. Thank you very much for your assistance.

MARLA J. POIRIER

Contracting Officer

Attachment Financial Information Sheet

1st Ind, (Name of Offeror’s Firm) (Date)

TO:

(Name of Financial Institution) (Phone # w/Area Code)

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

SIGNATURE:

BY:

(Print name/title of authorized representative)

RESPONSIBILITY QUESTIONNAIRE - FINANCIAL

FA460822R0001

Barksdale AFB MACC

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

2. Name of Financial Institution:

3. Address of Financial Institution:

4. How long has the firm been a commercial customer of your bank?

5. What is the type of account and its average* balance? (continue on separate sheet if necessary)

Checking $ Checking $

Savings $ Savings $

CD $ CD $

Money Market $ Money Market $ Other $

(SPECIFY TYPE)

6. Does the company maintain a loan balance at the bank? In what amount?

YES NO $

7. Does the company maintain an unsecured line of credit at the bank? In what amount?

YES NO $

8. What company’s standing with your bank?

Outstanding Excellent Satisfactory Poor Unsatisfactory

Other Explain on separate sheet of paper

9. COMMENTS:

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

(DATE)

SIGNATURE:

BY:

(Print name/title of authorized representative)

DATE: