Attachment 5, Financial Institution Reference Sheet.pdf
PDF 64 KB Posted
- Attached to
- Hurlburt Field - Integrated Solid Waste Management (refuse collection) Federal contract opportunity
- Solicitation number
- FA441720Q0001
About this file
This document contains a financial institution reference sheet template for a federal contract opportunity with the Department of the Air Force Special Operations Command to provide integrated solid waste management and refuse collection services at Hurlburt Field, Florida in accordance with the attached performance work statement. The solicitation number for this opportunity is FA441720Q0001. Offerors are required to include a completed reference sheet from each financial institution where they hold business accounts, authorizing the release of information about average monthly balances, current loans and lines of credit, payment history, and credit ratings to the contracting squadron for responsibility determinations. The financial institutions will provide information within designated fields on the lower portion of the form once it is sent to them.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Solicitation FA441720Q0001 - Questions and Answers (2).pdf | ||
| Solicitation Amendment FA441720Q00010002 SF 30.pdf | ||
| Attachment 1 Instructions to Offerors (Amended).pdf | ||
| Solicitation Amendment - FA441720Q00010002 Conformed.pdf | ||
| Solicitation FA441720Q0001 - Questions and Answers.pdf | ||
| Attachment 4 Performance Work Statement dated 10Jan2020.pdf | ||
| Solicitation Amendment FA441720Q00010001.pdf | ||
| Attachment 4, Performance Work Statement.pdf | ||
| Attachment 2, Evaluation.pdf | ||
| Attachment 1, Instructions to Offerors.pdf | ||
| Solicitation - FA441720Q0001.pdf | ||
| Attachment 3, Wage Determination 2015-4531 (Rev 11).pdf | ||
| Attachment 6, Past Performance Questionnaire .pdf |
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Text version
Attachment 5
FA441720Q0001
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your offer 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
| TO BE FILLED OUT BY CONTRACTOR: |
| TO BE FILLED OUT BY FINANCIAL INSTITUTION: |
| COMPANYS NAME: |
| Point of Contact POC Name: |
| POC Phone Number: |
| INSTITUTION NAME: |
| POC name: |
| POC title: |
| POC phone number: |
| fax number: |
| NameTitle: |
| 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 NSFs: |
| How long with this institution: |
| Credit rating with this institution: |
| I verify that the information provided above is current as of 1: |
| I verify that the information provided above is current as of 2: |
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