Attachment J23 - Financial Institution Reference Sheet.docx
DOCX document 20 KB Posted
- Solicitation number
- 75H701-23-R-00001
About this file
This document contains details for a federal construction contract solicitation. The Indian Health Service is seeking a contractor to perform maintenance and improvement renovations at the Phoenix Indian Medical Center in Phoenix, Arizona over a 300-day period of performance. Renovations include asbestos abatement, flooring replacement, mechanical HVAC improvements, interior and exterior painting, roof replacement, and fire alarm and sprinkler work. The construction magnitude is estimated between $1 million and $5 million. A pre-bid site visit is scheduled and a firm fixed price contract will be awarded using lowest price technically acceptable criteria. Offerors must register in the System for Award Management and check the website frequently for solicitation amendments.
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Text version
Attachment J23. Financial Institution Reference Sheet Solicitation 75H701-23-R-00001
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Offerors: Please fill out and return 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 of offers for contract award.
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: _______________POC Email: ______________ I give permission for the following information regarding my account(s) at your institution to be released to the Contracting Officer at the Indian Health Service – Division of Engineering Services – Seattle.
| ___________________________ | _________________________________________ | |
| Printed 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 of NSFs: ____________________________________ 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 |
You may return this form to Kelly Britton at Kelly.britton@ihs.gov.
File details come from the government source that posted it. Updated .