FA441720R0004 Attch 5 - Financial Worksheet.pdf

176 KB Posted

Attached to
CP1033735, SOF Alter STTS Vehicle/Watercraft Maintenance Areas, Bldg. 90540
Solicitation number
FA441720R0004
Issued by

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This document contains an attachment to a solicitation for proposals related to altering a building at Hurlburt Field, Florida to establish vehicle and watercraft maintenance areas for the Special Tactics & Training Squadron. The attachment requests a financial reference sheet to be completed by each financial institution with which an offeror has business accounts. The sheet seeks information on average monthly balances in checking and savings accounts, amounts of any current loans or lines of credit, details on any late payments or non-sufficient funds occurrences, length of relationship with the institution, and credit rating. The completed form would be sent to financial institutions for input should the offeror be selected as a potential awardee.

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Other files

File Type Posted
FA441720R0004 - Questions and Answers (Updated).pdf PDF
FA441720R0004 - Questions and Answers.pdf PDF
Solicitation Amendment - FA441720R00040001 - Changing Due Date for Questions.pdf PDF
Pre Proposal Site Visit Sign-in Sheet - 30 June 2020.pdf PDF
Pre Proposal Site Visit Memo - 30 June 2020.pdf PDF
Solicitation - FA441720R0004 - SOF Alter STTS Vehicle_Watercraft Maintenance Areas - Bldg 90540.pdf PDF
FA441720R0004 Attch 1 - Specifications.pdf PDF
FA441720R0004 Attch 2 - Drawings.pdf PDF
FA441720R0004 Attch 3 - Wage Determination.pdf PDF
FA441720R0004 Attch 6 - 50 Division Construction Cost Estimate Worksheet.xlsx XLSX spreadsheet
FA441720R0004 Attch 4 - PPQ.pdf PDF
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SOLICITATION NUMBER: _______________

ATTACHMENT 5 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 INFORMATION

Company Name: ________________________________________________________________

Point of Contact (POC) Name: ________________________________________________________________

POC Phone Number: ________________________________________________________________

INSTITUTION INFORMATION

Institution Name: ________________________________________________________________

POC Name: ________________________________________________________________

POC Title: ________________________________________________________________

POC Phone Number: ________________________________________________________________

POC Fax Number: ________________________________________________________________

POC Email: ________________________________________________________________

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

FINANCIAL INSTITUTION REFERENCE SHEET: FA441720R0004
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Point of Contact POC Name 1:
Point of Contact POC Name 2:
1:
2:
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4:
5:
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NameTitle:
Date:
Please give amounts as a range ie low four figures mid six figures etc:
Average monthly balance in savings 1:
Average monthly balance in savings 2:
Average monthly balance in savings 3:
Average monthly balance in savings 4:
Average monthly balance in savings 5:
Average monthly balance in savings 6:
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NameTitle_2:
Date_2:

File details come from the government source that posted it. Updated .