Attachment 4 - Financial Institution Ref.pdf
PDF 103 KB Posted
- Attached to
- FSC Ballistic Protection III_742nd
- Solicitation number
- FA452820R0010
About this file
This document contains an attachment for a solicitation seeking renovations to flight security controller facilities. The solicitation number is FA452820R0010 and involves renovating FSC offices, storage rooms, and bathrooms at five MAF sites through activities such as installing flooring, bullet-resistant windows and paneling, bullet-resistant doors and frames, painting, ceilings, countertops, electrical and plumbing systems, HVAC, and related work. The solicitation is being issued by the Department of the Air Force Global Strike Command. The attachment provides a financial institution reference sheet for contractors to submit with their proposals, allowing the banking institutions to provide information to aid the contracting agency's responsibility determination in the evaluation and award process.
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Attachment 4 – FA4528-20-R-0010
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: ______________________ 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
| TO BE FILLED OUT BY CONTRACTOR: |
| TO BE FILLED OUT BY FINANCIAL INSTITUTION: |
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