ATTACHMENT_5_RESPONSIBILITY.pdf
PDF 93 KB Posted
- Attached to
- ATFP Install Motorized Vehicle Gates Federal contract opportunity
- Solicitation number
- FA4460-10-R-0021
About this file
Attach 5 Financial Responsibility
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attach 7 SubKTR_Consent_Form.pdf | ||
| Attach 8 AF 66.pdf | ||
| 02-1071 Specs-Install Motorized Vehicle Gates.pdf | ||
| FA4460-10-R-0021 23 Jul 10.pdf | ||
| Attachment 2 EMIS Instruct Guide.pdf | ||
| NKAK 02-1071 Install Motorized Vehicle Gates 100 Design.pdf | ||
| Revised Attachment 1 Wage Decision.pdf | ||
| Attachment 4 C D Report.pdf | ||
| Attachment 6 Questionnaire.pdf | ||
| Attachment 3 Addendum to MOA.pdf |
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Text version
Solicitation Number: FA4460-10-R-0021
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’S NAME: ____________________________________________________________
Point of Contact (POC) Name: ______________________________________________________
POC Phone Number: ______________________________________________________________
INSTITUTION NAME: ___________________________________________________________
POC name: _____________________________________________________________________
POC title: ______________________________________________________________________
POC email address: ______________________________________________________________
POC phone number: ______________________ fax number: ___________________________
I give permission for the following information regarding my account/s at your institution to be released to SSgt
Brandon Davis and/or Mr Barry Jundt f the 19 th
Contracting Squadron, Little Rock AFB, Arkansas.
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
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