Attch 5 - Financial Worksheet.docx
DOCX document 22 KB Posted
- Attached to
- Addition to 24 SOW HQ Bldg 90310
- Solicitation number
- FA441720R0008
About this file
This solicitation is for an addition to the 24th Special Operations Wing Headquarters building at Hurlburt Field, Florida. The project includes minor demolition and new construction for a one-story addition with masonry walls, metal roof trusses, EIFS and scored CMU finishes to match the existing building. Interior finishes will also match existing. Site work such as relocating a picnic shelter and rerouting utilities is required. Expansion of mechanical, fire sprinkler, electrical and communication systems is included. The estimated value is between $1,000,000 and $2,000,000. The solicitation is set aside for women-owned small businesses and issued by the Department of the Air Force Special Operations Command. Offerors must register in SAM and proposals are due electronically by the closing date. The contract will be firm-fixed-price for a 300-day performance period. Payment and performance bonds are required within 10 days of award.
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Text version
ATTACHMENT 5
FA441720R0008
Financial Reference Worksheet
FINANCIAL INSTITUTION REFERENCE SHEET
03 Feb 2020
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 .