B01 Section J Attachment 4 - Financial Institution Reference Sheet.pdf
PDF 505 KB Posted
- Attached to
- Albuquerque SFC MATOC Federal contract opportunity
- Solicitation number
- 75H70120R00011
About this file
This document includes a financial institution reference sheet template and details of a federal solicitation for sanitation facilities construction services. The solicitation will result in the award of indefinite delivery, indefinite quantity multiple award task order contracts to between three to five contractors. Work will primarily be performed at various facilities in the Indian Health Service Albuquerque region but may also occur elsewhere in the United States or nationwide on individual task orders. Contractors must complete the financial institution reference sheet to provide information on business accounts from an average monthly balance to credit ratings to be considered for contract award. The reference sheets should be emailed to the identified contracting specialist. The base period of the contracts will be one year with four optional one-year extensions.
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Text version
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Forward this 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 in accordance with FAR Part 9.104-1.
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 Indian Health Service, Department of Engineering Services, Seattle, WA.
Name/Title Signature/Date
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
Email Reference Sheet to Mr. Matt Sanders(matt.sanders@ihs.gov)
Contract Specialist
Solicitation #75H7020R00011
ABQ SFC MATOC
Section J Attachment 4
File details come from the government source that posted it. Updated .