Atch_4_-_Financial_Institution_Reference_Sheet.pdf

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Attached to
Grounds Maintenance Re-Acquisition at Buckley AFB Federal contract opportunity
Solicitation number
FA254320R0002
Issued by
Department of the Air Force Space Command

About this file

This solicitation is for grounds maintenance services at Buckley Air Force Base in Colorado. The services include maintaining improved, semi-improved, and unimproved grounds as well as vegetative beds, drainage ditches, tree pruning and trimming, xeriscaping, planting, removal of shrubs and beds, and emergency and special event services. The requirement is a performance-based, firm fixed-price contract for one base year plus four option years, not to exceed five years total. The contract is set aside for certified HUBZone small businesses. Proposals are due by the deadline specified in block 8 of the solicitation and will be evaluated for technical acceptability, price, and past performance on an acceptable/unacceptable basis, with price being the determining factor for award.

Attachment 4 - Financial Institution Reference Sheet

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Text version

FA2543-19-R-A002

Attachment 4

FINANCIAL INSTITUTION REFERENCE SHEET

Instructions to Contractor: The following information is required to complete your determination of contractor responsibility as required by FAR 9.104. Please complete the below contractor portion; obtain the required financial information and necessary signature from your financial institution and return to your requesting Contracting Officer.

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:

Printed 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 of NSFs:

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

FINANCIAL INSTITUTION REFERENCE SHEET
TO BE FILLED OUT BY CONTRACTOR:
TO BE FILLED OUT BY FINANCIAL INSTITUTION:

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