FA301625R6000 Attach 5 Financial Disclosure.pdf
PDF 360 KB Posted
- Attached to
- Alteration and Fitting of Military Uniforms
- Solicitation number
- FA301625R6000
About this file
The document is a Contractor Responsibility Package for the Department of the Air Force, 502d Air Base Wing, Joint Base San Antonio, for the JBSA Alteration and Fittings project (Solicitation Number FA301625R6000). The package contains two primary documents: a Financial Disclosure Release Authorization form and a Financial Information form, which are part of the contractor responsibility determination process in accordance with FAR Part 9.
The Financial Disclosure Release Authorization requires the offeror to complete, sign, and submit a form authorizing the 502d Contracting Squadron to request financial information from the contractor's financial institution. The accompanying Financial Information form is a template to be completed by the financial institution, asking detailed questions about the contractor's account history, financial status, number and types of accounts, operational balance, line of credit, and overall ability to perform financial obligations for a project with potential six-figure annual value. These documents are administrative submissions and are not subject to proposal volume page count restrictions.
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DEPARTMENT OF THE AIR FORCE
502D AIR BASE WING
JOINT BASE SAN ANTONIO
FA301625R6000
JBSA ALTERATION AND FITTINGS
CONTRACTOR RESPONSIBILITY PACKAGE
The following documents and related instructions for completion have been provided for use in the Contractor Responsibility determination in accordance with FAR Part 9.
1) Financial Disclosure Release Authorization (pg.2): The offeror is instructed to complete, sign and submit page 2 of this form as part of its proposal submission. The Government may request information from at least one current financial institution or lender.
2) Financial Information (pg. 3,4): This form is provided as a sample so that offerors may see what information 502 CONS will ask of the financial institution. This form does not get submitted as part of the proposal.
Contractor responsibility documents are considered administrative submissions and therefore separate from any identified proposal package volume referenced at FAR 52.212-1 or 52.212-2 and are not subject to the page count restrictions related to those volumes.
FINANCIAL DISCLOSURE RELEASE AUTHORIZATION
FA301625R6000
JBSA ALTERATION AND FITTINGS
FINANCIAL INSTITUTION NAME: __________________________
FINANCIAL INSTITUTION ADDRESS:
FINANCIAL INSTITUTION POINT OF CONTACT (POC): _________________________________
FINANCIAL INSTITUTION TELEPHONE NUMBER: _______________________________
FINANCIAL INSTITUTION POC EMAIL:
TYPE OF ACCOUNT (checking/savings/etc.): _________________________________
I, __________________________ authorize release of the information requested on the (Insert name of contractor’s representative. Please print.) attached form(s) to the 502d Contracting Squadron, Joint Base San Antonio-Randolph.
All information provided will be safeguarded in accordance with procedures outlined in the Privacy Act of 1974 and DOD 5400.11R.
Signature
Title
Date
Company Name
FINANCIAL INFORMATION
FA301625R6000
JBSA ALTERATION AND FITTINGS
(To be completed by financial institution and returned via email to 502 CONS Contracting)
Contractor Name: _____________________________
Type of Account (checking/savings/etc.): _________________________________
Contractor's Financial Institution: _______________________________________
Financial Institution's Phone: ______________________________
Contractor's Financial Institution Point of Contact:
1. How long has the contractor had an account with your financial institution?
2. What is the contractor's current status with the financial institution? (e.g., poor, fair, good, excellent, outstanding) ___________________.
Any additional comments?
3. Has the company's accounting practices been satisfactory (yes or no)? ________.
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 (e.g., low, moderate, or high--five, six figure, etc.) ?
6. Does the contractor have a line of credit (yes or no)? ________ If yes, is the line of credit authorized Low, moderate, or high--five, six figure, etc.?
Attn. Emily Deck Sanders emily.deck_sanders@us.af.mil Contracting Officer
Kailah Kraus kailah.kraus@us.af.mil Contract Specialist
7. Based on the contractor's financial history, current status, and the magnitude of this project (six figures or more annually), do you feel the contractor will be able to perform his financial obligation (yes or no)?
If no, why (in terms that will not violate what you as a financial institution are allowed to disclose)?
Signature
Date
Title
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