Attachment 2 -- Responsibility Questionnaire.doc

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Paramedic Services
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FA4528-09-R-0026
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Responsibility Questionnaire

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FA4528-09-R-0026

Attachment 2

RESPONSIBILITY QUESTIONAIRE

The following information is needed to help evaluate and determine your company responsible. Please complete the following items and submit with your proposal:

a. The name of your banking institutions, to include points of contact and phone numbers.

Name of Bank: ________________________________________________________ Address: _____________________________________________________________

Name of POC: ________________________________________________________

Telephone No: ________________________________________________________

b. The names of up to three (3) customers/contracts that you have held or done business with, to include points of contact and phone numbers.

I. Name of Customer/Contract: ____________________________________________

Address: ______________________________________________________________

Name of POC: _________________________________________________________

Telephone No: _________________________________________________________

II. Name of Customer/Contract:____________________________________________

III. Name of Customer/Contract:___________________________________________

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