Attachment T - Financial Reference Worksheet.pdf
PDF 878 KB Posted
- Solicitation number
- FA483026R0002
About this file
This is a Financial Institution Reference Sheet template for federal contract evaluation purposes, specifically for solicitation FA483026R0002 issued by the 23D Contracting Squadron at Moody Air Force Base, Georgia.
The form serves as a contractor responsibility determination tool used during award evaluation. Contractors must submit a completed reference sheet for each financial institution where they maintain business accounts. The contractor-completed section requires the company name, point of contact information, and authorization for the government to contact the financial institution. The financial institution-completed section requests specific account information presented as ranges (e.g., low four figures, mid six figures), including average monthly checking and savings balances, current loan amounts, lines of credit, history of late payments or non-sufficient funds (NSF) incidents, length of relationship with the institution, and the institution's credit rating of the contractor. The form includes signature and date fields for both contractor and financial institution representatives to verify the accuracy and currency of the provided information. This template is used only when a firm is selected as the potential awardee, at which point the government sends the completed form directly to the contractor's banking institution for verification.
View the file
Other files
Show all 22
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
FA483026R0002
Attachment T
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your quote 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 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 23D Contracting Squadron, Moody AFB, GA.
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
| TO BE FILLED OUT BY CONTRACTOR: |
| TO BE FILLED OUT BY FINANCIAL INSTITUTION: |
| COMPANYS NAME: |
| Point of Contact POC Name: |
| POC Phone Number: |
| INSTITUTION NAME: |
| POC name: |
| POC title: |
| POC phone number: |
| fax number: |
| NameTitle: |
| 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 NSFs: |
| How long with this institution: |
| Credit rating with this institution: |
| I verify that the information provided above is current as of 1: |
| I verify that the information provided above is current as of 2: |
File details come from the government source that posted it. Updated .