Attch 5 - Financial Institution Reference Sheet.pdf

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Attached to
Convert Mini-Mall to Admin Facility, Bldg. 90228
Solicitation number
FA441721B0001
Issued by

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This document contains an attachment to a federal solicitation for conversion of a mini-mall building into an administration facility. The attachment requests financial references from offerors by including a template for a Financial Institution Reference Sheet. The sheet is to be filled out by both the offeror and their financial institution, with the institution providing information such as average monthly balances, amount of any loans or lines of credit, payment history, and length and nature of the relationship. If selected for award, the completed form would be sent to the financial institution for verification. The solicitation number and converting the mini-mall building are also referenced.

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Other files

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FA441721B0001 - Questions and Answers.pdf PDF
Memo for Record - FA441721B0001 Pre-Proposal Conference_Site Visit.pdf PDF
FA441721B0001 - Pre Proposal Conference_Site Visit Sign-in Roster.pdf PDF
Attch 4 - DBA Wage Determination FL20210217.pdf PDF
Attch 2 - Drawings for Min-Mall Conversion Bldg 90228.pdf PDF
Solicitation - FA441721B0001.pdf PDF
Attch 3 - Working Time Analysis for Min-Mall Conversion Bldg 90228.pdf PDF
Attch 1 - Specifications for Min-Mall Conversion Bldg 90228.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: FA441721B0001
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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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