Attachment J06 - Financial Institution Reference Sheet.pdf
PDF 140 KB Posted
- Attached to
- PH21PH01H5 PIMC Elevator Modernization Federal contract opportunity
- Solicitation number
- PH21PH01H5
About this file
This solicitation notice seeks proposals for the elevator modernization project at the Phoenix Indian Medical Center in Phoenix, Arizona. The scope of work involves modernizing four passenger elevators that serve six floors of the main hospital building. Services include removing and disposing of outdated components, supplying and installing new components, refurbishing existing parts, renovating cab interiors, performing electrical work, providing preventative maintenance and a minimum one-year warranty. The period of performance is 300 calendar days from notice to proceed. The estimated value of the contract is between $1 million and $5 million. The pre-proposal question deadline is 10 days before the June 7, 2021 proposal due date. This is a 100% small business set-aside solicitation under NAICS code 238290 with a size standard of $16.5 million average annual revenue.
View the file
Other files for this federal contract opportunity
Show all 20
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment J06. Financial Institution Reference Sheet Solicitation 75H701-21-R-00025
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Forward this 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 in accordance with FAR Part 9.104-1.
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: ______________________ fax number: _______________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the Indian Health Service, Department of Engineering Services, Seattle, WA.
Name/Title Signature/Date
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
Email Reference Sheet to Ms. Kelly Britton, Contracting Officer at Kelly.britton@ihs.gov mailto:Kelly.britton@ihs.gov
FINANCIAL INSTITUTION REFERENCE SHEET
File details come from the government source that posted it. Updated .