Attch_9 _FA3016-16-R-0021 _Financial_Information_Questionnaire.docx

FA3016-16-R-0021, Attachment # 9

FINANCIAL INFORMATION QUESTIONNAIRE

Contractor’s Name __________________________________________________

Name of Proposed Contract Service ____________________________________

Financial Institution: ________________________

Point of Contact_____________________ Phone Number______________________ E-mail Address_______________________

1. How long has the contractor been with the institution? _______________________

2. What is the contractor’s current status with the institution? (i.e. poor, fair, good, excellent, outstanding)_________________ Additional comments: _______________________________________________

3. Have the company’s accounting practices been satisfactory? __________________ If no, why? ________________________________________________________

4. How many accounts and what types of accounts does the company have with the institution?

a. ____________________________________________________________________

b. ____________________________________________________________________

c. ____________________________________________________________________

5. What is the company’s current operational balance? (i.e. low, moderate, or high-five, six figure, etc.) ____________________________

6. Does the contractor have a line of credit? __________ (i.e. low, moderate, or high-five, six figures etc.) ____________________________

7. Based on the contractor’s financial history, current status, and the magnitude of this project (six figure per year), how do you feel the contractor will be able to perform his financial obligation?

8. The Government reserves the right to validate the above information by contacting the financial institution.

Signature

Name (please type or print)

Title

Date