Attach_5_Auth_Release_of_Fin_Info.docx

ATTACHMENT 5

FA2823-15-R-3005

AUTHORIZATION FOR THE RELEASE OF FINANCIAL INFORMATION

Instructions to Contractor: Complete the form below and return a signed copy along with your proposal. The authorization is required so that the Government can expedite the award process by having on-hand a signed authorization enabling it to contact the apparent awardee’s financial institution. The purpose of the letter will be to determine if the apparent awardee has adequate financial resources to perform the contract, or the ability to obtain them. The letter the Government will send will asks how long you have had your account, estimated current line of credit, and whether or not they have received any non-payment complaints. This letter will be sent to the financial institution(s) as a part of the required contractor responsibility determination in accordance with FAR 9.104-1. If you have more than one financial institution, complete a separate form for each institution.

TO BE FILLED OUT BY CONTRACTOR:

COMPANY___________________________________________________________________

Point of Contact (POC) Name: ____________________________________________________ POC Phone Number: ____________________________________________________________ POC Email: ___________________________________________________________________

FINANCIAL INSTITUTION NAME: ______________________________________________

POC name: ____________________________________________________________________ POC title: _____________________________________________________________________ POC phone number: ______________________ fax number: ____________________________ POC Email: ___________________________________________________________________

I give permission for the following information regarding my account/s at your institution to be released to representatives of AFTC/PZIOA Operational Contracting Division at Eglin AFB, FL.