Attachment 11 - Financial Questionnaire.docx
DOCX document 30 KB Posted
- Attached to
- Civil Works IDIQ 2024 - Hurlburt Field, FL
- Solicitation number
- FA441724CivilWorks
About this file
This document provides details regarding an upcoming Civil Works Indefinite Delivery Indefinite Quantity contract opportunity at Hurlburt Field, Florida. The single award IDIQ contract will have a one year base period and four one year option periods and will be for repair, replacement, and minor construction of base infrastructure including pavements, water and wastewater systems, and facilities. The work will be performed through task orders issued against the IDIQ and will have an estimated total value of over $10 million. Prospective contractors must register in SAM prior to January 2024 and have a current NIST SP 800-71 security assessment to be considered for award. The solicitation is anticipated to be released on or about February 29, 2024 and will only be available via SAM.gov. Bid bonds will be required with proposals and payment and performance bonds within ten days of award.
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Text version
FOR OFFICIAL USE ONLY
SOURCE SELECTION SENSITIVE – SEE FAR 3.104
ATTACHMENT 5
FA2823-15-R-4037
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 Contracting Squadron, Eglin AFB, 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 |
FOR OFFICIAL USE ONLY
SOURCE SELECTION SENSITIVE – SEE FAR 3.104
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