Attach 5 Financial Institution Ref Sheet.pdf
PDF 93 KB Posted
- Attached to
- LRAFB Multiple Award Construction Contract (MACC) Federal contract opportunity
- Solicitation number
- FA4460-11-R-0008
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Attachment 5 Financial Institution Ref Sheet
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| Attach 8 AF66 Seed Project.pdf | ||
| Attach 6 SURETY REFERENCE SHEET.pdf | ||
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| FA446011R0008 Solicitation.pdf | ||
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Text version
SOLICITATION NO.: FA4460-11-R-0008
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 representatives of 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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