Attch 5 Financial Worksheet dated 06 Jan 2022.docx
DOCX document 25 KB Posted
- Solicitation number
- FA441722R0001
About this file
This document contains an attachment template for a financial reference worksheet and information on a related federal contract opportunity for building alterations. The financial worksheet template requests a contractor provide banking references to be contacted regarding the firm's financial responsibility as part of the proposal evaluation. Information sought includes average account balances, loans, lines of credit, late payments and the length and credit rating of the banking relationship.
The related federal contract opportunity is a solicitation to modify an existing dormitory area into office spaces in building 90322 at Hurlburt Field, Florida for the 492nd Special Operations Wing. Work includes removing dormitory partitions and accessories and installing new office layouts, lighting, HVAC, electrical and an antenna support tower. Proposals are due under solicitation number FA441722R0001 for alterations to interior and exterior areas of the specified building to accommodate the office renovations.
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ATTACHMENT 5
FA441722R0001
Financial Reference Worksheet
FINANCIAL INSTITUTION REFERENCE SHEET
06 Jan 2022
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’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 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 |
File details come from the government source that posted it. Updated .