Attch 5 Financial Reference Sheet (dated 17May 2021).pdf

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Attached to
Renovate Bldg 90063, 505 CTS Hurlburt Field
Solicitation number
FA441721R0015
Issued by

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This document contains an attachment requesting financial reference information from contractors responding to Solicitation Number FA441721R0015 for the renovation of Building 90063 at Hurlburt Field. The solicitation involves interior renovations to provide an office space, break room, lactation room, and restrooms on the main floor with movable partition walls. A new fire sprinkler and mass notification system, mechanical system, and ramps at three exit doors are also included. All new interior finishes will be installed. The Department of the Air Force Special Operations Command is the agency listed. Contractors are asked to provide banking references including average monthly balances, current loans, lines of credit, late payments or NSFs, length of relationship, and credit rating. Financial institutions will be contacted to verify details for contractor responsibility if the contractor is selected as the potential awardee.

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SOLICITATION NUMBER: FA441721R0015

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

17 May 2021

FINANCIAL INSTITUTION REFERENCE SHEET:
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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