Attch 5 Financial Worksheet dated 06 Jan 2022.docx
DOCX document 22 KB Posted
- Attached to
- Repair HVAC, 705 TRS Bldg 90067
- Solicitation number
- FA441722B0003
About this file
This document contains an attachment for a solicitation to repair the HVAC system in building 90067 for the 705th Training Squadron at Hurlburt Field, Florida. The mechanical work includes replacing two split system heat pumps with new pumps to accommodate the building's load, replacing a gas fired water heater with an electric water heater, and installing new diffusers, grilles, and controls. Existing gas piping will be removed and capped, some ductwork in the auditorium will be reused, and remaining ductwork demolished with new ductwork installed. The electrical work includes disconnecting existing equipment, removing conduit and devices back to the server panel, and installing new wiring, conduit, and disconnects for all new HVAC equipment with the existing 200 amp panel remaining to feed the new mechanical equipment and water heater. Offerors are required to provide financial references from institutions using the attachment form.
The solicitation is being conducted by the Department of the Air Force Special Operations Command for Capital Project 1045103.
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Text version
ATTACHMENT 5
FA441722B0003
Financial Reference Worksheet
FINANCIAL INSTITUTION REFERENCE SHEET
01 Jul 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 .