Attachment 5_Financial Institution Reference Sheet_Undated_1 page.pdf

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FTEV 16-1183, Renovate Office Space, 492 SOACS, Building 90322
Solicitation number
FA441720R0012
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This pre-solicitation notice seeks proposals for the renovation of office space at Building 90322 on Hurlburt Field, Florida. The project involves modifying an existing dormitory area on the first floor northeast wing to accommodate a new office area and command suite for the 492nd Special Operations Civil Engineer Squadron. Renovations will include removing existing dormitory partitions and installing new office spaces, with associated lighting, HVAC, electrical and interior partition work. The estimated value is between $500,000 and $1,000,000. The solicitation is anticipated to be released on or around June 15, 2020, with a 184-day period of performance. This will be a 100% HUBZone small business set-aside awarded as a firm-fixed-price contract by the Air Force Special Operations Command. Interested parties must register in the System for Award Management and monitor the Federal Business Opportunities website for award details.

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SOLICITATION NUMBER: FA441720R0012

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

Attachment 5, Financial Institution Reference Sheet, Undated, 1 page

FINANCIAL INSTITUTION REFERENCE SHEET:
undefined:
Point of Contact POC Name 1:
Point of Contact POC Name 2:
1:
2:
3:
4:
5:
6:
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:
undefined_2:
NameTitle_2:
Date_2:

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