Past and Present Performance Questionnaire.docx
DOCX document 38 KB Posted
- Solicitation number
- FA452827Q0005
About this file
This is a Past and Present Performance Questionnaire and Financial Institution Reference form required for proposal submission under solicitation FA4528-27-Q0005 for the FY 27 Fire Department Trainer Maintenance & Winterization/De-Winterization opportunity with the Department of the Air Force Global Strike Command.
Contractors must provide documentation of up to three customer references or contracts previously held, including customer name, address, point of contact with phone number, performance dates, annual dollar value, and description of services performed. Additionally, contractors must submit a Financial Institution Reference Sheet for each business banking account, which requires the contractor to authorize release of account information to the 5th Contracting Squadron at Minot Air Force Base, North Dakota. The financial institution must complete the second section of the form if the contractor is selected as the potential awardee, providing account balance ranges for checking and savings accounts, current loan amounts, lines of credit status, payment history, length of banking relationship, and credit rating. The form specifies that financial information should be reported in ranges (e.g., low four figures, mid six figures) rather than exact amounts. These forms are used to evaluate contractor responsibility and financial capability as part of the award evaluation process.
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RESPONSIBILITY QUESTIONNAIRE
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 names of up to three (3) customers/contracts that you have held or done business with, including points of contact and phone numbers.
I. Name of Customer/Contract:
Address:
Name of POC:
Telephone No:
Dates/Years of Performance:
Annual $ Value:
Services Performed/Additional Comments:
II. Name of Customer/Contract:
Address:
Name of POC:
Telephone No:
Dates/Years of Performance:
Annual $ Value:
Services Performed/Additional Comments:
FA4528-27-Q0005
III. Name of Customer/Contract:
Address:
Name of POC:
Telephone No:
Dates/Years of Performance:
Annual $ Value:
Services Performed/Additional Comments:
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 regarding 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:
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 NSFs: | 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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