Atch_5_-_Financial_Worksheet _16R0017.docx
DOCX document 24 KB Posted
- Attached to
- Construct Addition to Bldg 90020 Federal contract opportunity
- Solicitation number
- FA4417-16-R-0017
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Attachment 5 Financial Questionnaire to Solicitation FA4417-16-R-0017 Construct Addition to Bldg 90020
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| Questions_Answers_1_thru_10 _16_Jun_2016 _16-R-0017.pdf | ||
| Site_Visit_Sign-in_Sheet_and_Memorandum_for_Record.pdf | ||
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| Solicitation _FA4417-16-R-0017.docx | DOCX document | |
| Atch_6 _ _Additional_Contract_Requirements.docx | DOCX document | |
| Atch_4_-_PPQ _16R0017.docx | DOCX document | |
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Text version
ATTACHMENT 5
FA4417-16-R-0017
Financial Reference Worksheet
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your proposal a reference sheet for each financial institution that you have a business account with. This sheet may be sent to the banking institution/s in regards to a determination of contractor responsibility as part of the evaluation for award of this solicitation.
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: _______________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 1st Special Operations Contracting Squadron, Hurlburt Field, FL.
| _____________________________________ | ________________________________ | |
| Name/Title | Signature/Date |
DO NOT HAVE THIS SECTION FILLED OUT. IF YOUR FIRM IS SELECTED AS THE POTENTIAL AWARDEE, THIS FORM WILL BE SENT TO YOUR BANKING INSTITUTION FOR COMPLETION.
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 or NSF’s? ______________ 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 |
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