Attch 5 - Financial Institution Reference Sheet.pdf

PDF 177 KB Posted

Attached to
2021 Civil Works IDIQ Federal contract opportunity
Solicitation number
FA441721R0002
Issued by
Department of the Air Force Special Operations Command

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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: FA441721R0002
undefined:
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:
undefined_2:
NameTitle_2:
Date_2:

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