Attch 4 - Financial Institution Reference Sheet.pdf

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Attached to
Repair of Lift Station 92420
Solicitation number
FA441722B0002
Issued by

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This solicitation seeks bids for the repair of Lift Station 92420. The project involves repairing lift station number 92420 according to the attachments listed in Section J. It is a Service-Disabled Veteran-Owned Small Business set-aside under NAICS code 236220 with an estimated value between $215,000 and $250,000. Bidders must clearly label bid packages with their company and DUNS/CAGE code, the solicitation number, and project description, to be opened on the specified date and time. The solicitation will be awarded following FAR Part 14 for sealed bidding. Bidders are responsible for submitting bids by the date and time specified and should review the solicitation and attachments for full details. The soliciting agency is the Department of the Air Force Special Operations Command.

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FA441722B0002 Site Visit Log 29June2022.pdf PDF
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Solicitation Amendment FA441722B00020001 SF 30 (1).pdf PDF
Attch 3 DOL Wage Determination_FL20220127_25 Feb 2022.pdf PDF
Solicitation - FA441722B0002.pdf PDF
Attch 1 Drawing Repair Lift Station 92420.pdf PDF
Attch 2 Specifications Repair Lift Station 92420.pdf PDF

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SOLICITATION NUMBER: _______________

ATTACHMENT 5 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 INFORMATION

Company Name: ________________________________________________________________

Point of Contact (POC) Name: ________________________________________________________________

POC Phone Number: ________________________________________________________________

INSTITUTION INFORMATION

Institution Name: ________________________________________________________________

POC Name: ________________________________________________________________

POC Title: ________________________________________________________________

POC Phone Number: ________________________________________________________________

POC Fax Number: ________________________________________________________________

POC Email: ________________________________________________________________

I give permission for the following information regarding my account/s at your institution to be released to representatives of the 1st Special Operations Contracting Squadron, Hurlburt Field, FL.

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

FINANCIAL INSTITUTION REFERENCE SHEET: FA441722B0001
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Point of Contact POC Name 1:
Point of Contact POC Name 2:
1:
2:
3:
4:
5:
6:
NameTitle:
Date:
Please give amounts as a range ie low four figures mid six figures etc:
Average monthly balance in savings 1:
Average monthly balance in savings 2:
Average monthly balance in savings 3:
Average monthly balance in savings 4:
Average monthly balance in savings 5:
Average monthly balance in savings 6:
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NameTitle_2:
Date_2:

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