Attachment 8 - Financial Institution Reference Sheet.pdf
PDF 180 KB Posted
- Attached to
- Base Telecommunication System Service, Minot AFB Federal contract opportunity
- Solicitation number
- FA452821R0010
About this file
This document contains a financial institution reference sheet template and information on 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 government to verify financial information as part of the responsibility determination for awarding the telecommunication services contract. The contract opportunity is 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. The acquisition is for ongoing operation and maintenance of existing systems to keep the base telecommunication network operational at all times.
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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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