Endorsement A - Financial Standing Questionnaire.pdf

CUI/SSEL/FED ONLY

“Source Selection Information – See FAR 2.101 and 3.104”

CUI

ENDORSEMENT A

FINANCIAL STANDING QUESTIONNAIRE

A primary consideration in the source selection process is to determine an offerors qualification, responsibility, and financial standing. Prior to awarding a contract, per Federal Acquisition Regulation (FAR) Part 9, the Government must determine, through acceptable evidence, that an offeror has adequate financial resources, or the ability to obtain the financial resources, to perform the contract. The substantive answers in Attachment A are to be completed by the offerors financial institution. Offerors should obtain a bank stamp or seal AND signature of the referenced individual on the questionnaire. Failure to provide the requested information may render an offerors proposal non-responsible, and cause it to be removed from competition.

GENERAL INFORMATION (to be completed by the contractor):

Contractor’s Name and address:

Point of Contact:

Telephone:

Email:

Solicitation number:

RESPONDENT INFORMATION (to be completed by an authorized Financial Institution representative):

Full Name and Title:

Name of Financial Institution:

Address:

Telephone/Fax:

Email address:

“Source Selection Information – See FAR 2.101 and 3.104”

CUI

1. Does the contractor have an active account(s) with your financial institution? If yes, how many?

2. How long have the account(s) been active?

3. What are the account(s) average balance (digits only)?

4. How many returns (insufficient funds) has the contractor had in the last 12 months?

5. Does the contractor currently have outstanding loans? If yes, a) how many; b) what are the balances due on those loans (digits only); and c) is the contractor making payments in accordance with the terms of the loans?

6. In the last 12 months, has the contractor been able to meet its financial obligations on time?

7. Does the contractor have a line of credit? If so, a) what is the credit limit (digits only);

and b) how much credit is presently available for use (digits only)?

If you need additional space to respond, please indicate that additional documentation was provided in response your above answers.

“Source Selection Information – See FAR 2.101 and 3.104”

CUI

Certificate of Authority

I, ______________________ certify that as ______________________ of (Insert name) (Insert job title)

______________________ I am duly authorized to execute this form.

(Insert corporation name)

Signature _______________________________________ Date ___________

(Financial Institution Seal/Stamp)