Financial Institution Reference Sheet.docx
DOCX document 35 KB Posted
- Solicitation number
- FA465426R0002
About this file
This is a Financial Institution Reference Sheet template used for contractor responsibility evaluation. Contractors responding to solicitation FA465425B0001 (Project CTGB 162017, Add/Renovate Aircraft Maintenance Shop FAC 453 at Grissom Air Reserve Base, Indiana) must complete and submit this form for each financial institution with which they maintain a business account. The form requests the contractor's company name and point of contact information, along with the financial institution's name, contact details, and authorization for the USAF AFRC 434 CONF/LGC at Grissom ARB to contact the institution directly.
The financial institution completes the second portion of the form by providing account information in ranges, including average monthly balances in checking and savings accounts, current loan amounts, lines of credit, payment history (late payments or NSF incidents), length of relationship with the institution, and overall credit rating. This reference sheet serves as a documentation tool for verifying contractor financial stability and creditworthiness as part of the solicitation evaluation process. The form requires authorization signatures from both the contractor and the financial institution representative to validate the disclosed information.
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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 .