Financial Institution Reference Sheet.docx
DOCX document 37 KB Posted
- Solicitation number
- FA465426R0004
About this file
This is a Financial Institution Reference Sheet template used for contractor responsibility evaluation. The form is Attachment 9 to solicitation FA465425B0001 for Project CTGB 162017, an Add/Renovate Aircraft Maintenance Shop at Grissom Air Reserve Base, Indiana. The contractor must complete and return a separate reference sheet for each financial institution with which it maintains business accounts. The form collects company name and point of contact information from the contractor, which is then submitted to the financial institution for verification. The financial institution completes the form by providing account information in ranges (such as low four figures or mid six figures) including average monthly balances in checking and savings accounts, current loan amounts, lines of credit, payment history noting any late payments or non-sufficient funds, length of relationship with the institution, and credit rating. The contractor must provide written permission authorizing release of account information to USAF AFRC 434 CONF/LGC at Grissom ARB, Indiana. Both the contractor and financial institution representatives must sign and date their respective sections to certify the accuracy of the information provided as of the signature date.
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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 .