Attachment 5 - Financial Reference.docx
DOCX document 16 KB Posted
- Attached to
- Minot AFB MACC Federal contract opportunity
- Solicitation number
- FA452820R0008
About this file
This document contains a financial reference sheet template for Attachment 5 of solicitation FA4528-20-R-0008, a Multiple Award Construction Contract from the Department of the Air Force Global Strike Command at Minot Air Force Base. The financial reference sheet requires contractors to provide banking references including average monthly balances in checking and savings accounts, amounts of any current loans or lines of credit, and credit history over the past year. Contractors authorize their banking institutions to disclose this information to the 5th Contracting Squadron to aid in responsibility determinations for potential contract awards. The financial reference sheet is to be sent to the contractor's banks for completion if the contractor is selected as a potential awardee.
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Text version
FA4528-20-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 email address:____________________________________________________________ POC title: ____________________________________________________________________ POC phone number: ______________________ fax number: ___________________________ Account #_______________________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 5th Contracting Squadron, Minot AFB, North Dakota.
| _____________________________________ | _____________________________________ | |
| 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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