Attch_8_-_Financial_Institution_Ref_Sheet_Blank.pdf

Repair Hickam Ave FA4427-18-R-0018

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: ____________________

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: ________________

I verify that the information provided above is current as of ______________________