FINANCIAL_INSTITUTION_REFERENCE_SHEET.pdf

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Attached to
JB Charleston Grounds Maintenance Services Federal contract opportunity
Solicitation number
FA4418-14-R-0012
Issued by
Department of the Air Force Air Mobility Command

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Financial Institution Reference Sheet

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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 FA4418-14-R-0012.

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 628th Contracting Squadron, Joint Base Charleston, South Carolina.

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.

PLEASE EMAIL OR FAX COMPLETED FORM TO: Scott D. Rogge (scott.rogge.1@us.af.mil) Fax: 843-963-5183

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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