Attachment 8 - Financial Institution Reference Sheet.pdf

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Attached to
Base Telecommunication System Service, Minot AFB Federal contract opportunity
Solicitation number
FA452821R0010
Issued by
Department of the Air Force Global Strike Command

About this file

This document contains a financial institution reference sheet template and details of a federal contract opportunity for base telecommunication system services at Minot Air Force Base in North Dakota. The financial institution reference sheet is to be filled out by contractors and sent to their banks to allow the Air Force to verify financial details as part of the responsibility determination for awarding the telecommunications contract. The contract provides for operation and maintenance of the base telephone system, switch, inside and outside plant systems, network, transmission systems, and associated equipment. The services are required to ensure system availability 24/7. The contracting agency is the Department of the Air Force Global Strike Command for this pre-solicitation notice.

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Text version

FA452821R0010

Attachment 8

Financial Institution Reference Sheet

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 email address:____________________________________________________________

POC title: ____________________________________________________________________

POC phone number: ______________________ fax number: ___________________________

Account #_______________________________

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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