Financial Institution Reference Sheet.docx

DOCX document 35 KB Posted

Attached to
Project CTGB 26-3102, REPAIR (REPLACE) INFRARED HEATERS, B438
Solicitation number
FA465426R0001
Issued by

About this file

This is a Financial Institution Reference Sheet template designed for contractor responsibility evaluation in federal contracting. The document serves as Attachment 9 for solicitation FA465425B0001 and is issued by the USAF AFRC 434 CONF/LGC at Grissom Air Reserve Base, Indiana, for Project CTGB 162017 (Add/Renovate Aircraft Maintenance Shop FAC 453). Contractors are required to complete and submit one reference sheet for each business financial institution where they maintain accounts. The form collects contractor information including company name and point of contact details, followed by financial institution-specific data on average monthly checking and savings balances, current loans, lines of credit, payment history, account tenure, and credit rating. Financial institutions complete their portions by providing account balance information in ranges and certifying the currency of the data.

The reference sheet enables the government to verify contractor financial responsibility and stability as part of the evaluation process for determining contractor capability to perform on the federal contract. Contractors grant permission for the Air Force to contact their financial institutions directly to obtain the referenced account and credit information. This template is a standard responsibility assessment tool used in federal procurement to ensure contractors have adequate financial resources to successfully execute contract obligations.

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Text version

19 JAN 2025

Attachment 9

FA465425B0001

FINANCIAL INSTITUTION REFERENCE SHEET

Instructions to Contractor: Please fill out and return 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 solicitation number FA465425B0001, Project CTGB 162017, Add/Renovate Aircraft Maintenance Shop FAC 453, Grissom Air Reserve Base, IN

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:

I give permission for the following information regarding my account(s) at your institution to be released to representatives of the USAF AFRC 434 CONF/LGC, Grissom ARB, IN.

Printed Name/Title Signature/Date

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 of 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

File details come from the government source that posted it. Updated .