Attachment_4_Financial_Responsibility_Questionnaire.pdf

FA002119RA004

Attachment 4

FINANCIAL RESPONSIBILTY QUESTIONNAIRE

Contractor Information:

Name: ________________________________________________________________________

Address: ______________________________________________________________________

Point of Contact (POC): _________________________________________________________

Telephone: ____________________________________________________________________

E-mail: _______________________________________________________________________

FINANCIAL INSTITUTION:

The above named contractor is currently competing for a contract to perform Air Force Special Operations Command (AFSOC) MC-12 Mission Aircrew for JAVAMAN Tactical Systems Operators (TSOs) at Will Rogers Airport, Ok. As part of the financial responsibility determination required by FAR 9.104-1, please provide the following information to be included in the contractor’s proposal submission. This information wll be kept secure and only those who have a need to know will view this document. Any questions concerning this form can be directed to the Contracting Officers, Ms. Angela Maher, telephone: (850) 884-2435, E-mail:

angela.maher@us.af.mil or Mr. Steven McConnaughy, telephone: (850) 884-5999, E-mail:

steven.mcconnaughy.1@us.af.mil. Your assistance is greatly appreciated!

Financial Institution Name: _______________________________________________________

Financial Institution Address: _____________________________________________________

Point of Contact (POC): __________________________________________________________

POC Title: _____________________________________________________________________

POC Phone: ___________________________________________________________________

POC E-mail Address: ____________________________________________________________ mailto:angela.maher@us.af.mil mailto:steven.mcconnaughy.1@us.af.mil

FA002119RA004

Attachment 4

QUESTIONS:

1. How long has the contractor’s account(s) been open? _________________________________

2. What is the average balance in the account? _________________________________________ (State high 6 figure, low 7 figure, etc.)

3. Does the customer have a credit line available? _____________________________________

a. If so, what amount of credit is available? ________________________________________

(State high 6 figure, low 7 figure, etc.)

4. Is the customer’s account (s) in good standing? ______________________________________

5. Does the institution feel comfortable continuing to support this customer in their business endeavors? ____________________________________________________________________

6. Additional remarks, if any: _____________________________________________________

POC Signature: _______________________________________ Date: ___________________