Attachment 12 Draft Financial Responsibility.doc

FA2486-20-F-1001

Attachment 12

FINANCIAL RESPONSIBILITY QUESTIONNAIRE

SUSPENSE: In-line with Fair Opportunity Proposal Request (FOPR) Submission Deadline Contractor Information:

Name:

Address:

Point Of Contact (POC): ________________________________________________________________ Phone/ Email: _________________________________________________________________________ To be Completed by Financial Institution:

The above named contractor is currently proposing a solution for performing services pertaining to the United States Air Force (USAF). As part of the financial responsibility determination required by FAR 9.104-1, please complete the following and return to the above Contractor POC by their need date, so the Contractor can submit their proposal no later than proposal due date.

If you have any questions, please call Adam Vance at (850) 882-0159. Your assistance is appreciated.

Institution Name:

Address:

POC:

Title:

Phone:

Email:

1. How long has the account(s) been open? _____________________________________________

2. Over the previous six months, what is the average balance in the account? _______________________________________

3. Does the customer currently have (or ability to obtain) a credit line contingent upon award of this Task Order? _______________________________________ If so, what amount of credit is available? ____________________________________________

4. Additional remarks, if any:________________________________________________________ Financial Institution POC:

Signature: _____________________________ Date: ___________________

FA2486-20-F-1001

Attachment 12