Exhibit A_ Financial Questionnaire.pdf

VTE Maintenance San Diego Metropolitan Area

N62473-21-R-0018

Rev. Jan 2018

EXHIBIT A

FINANCIAL QUESTIONNAIRE

SOLICITATION NO: N62473-21-R-0018

(To be completed and submitted via secure email by the Financial Institution ) NAVFAC Southwest is currently considering award of a Navy contract to this firm. Prior to award, the Navy requests the financial information listed below with regard to this firm. In order to be responsive to the Navy’s needs, it is requested that you complete this financial questionnaire with regard to this firm. Upon completion of the questionnaire it is requested that you submit the completed questionnaire via email to samantha.m.king@navy.mil and rea.estrella@navy.mil. The requested information must be received by the contractor no later than ___________________________ Prospective Contractor for which information is being requested:

Name: ______________________________________________________________ Address: ____________________________________________________________ City/State/Zip: ________________________________________________________ Phone Number: _______________________________________________________ Point of Contact: ______________________________________________________

Signature of Prospective Contractor or Contractor Representative Requesting Financial Information Name of Financial Institution:

Address:

Phone Number: _________________________________________________________ Account Number: __________________________________________ Type of Account: __________________________________________ Average Balance Figure: ___________________________________________ Does the Contractor have a line of credit? Yes No

What is the limitation? __________________ Remaining balance:

What is the Contractor’s relationship with the bank:

Outstanding Satisfactory Other (explain):

How long has the Contractor been a client? _______________________________

Signature of person providing the above information

Print Name and Title of person providing the above information