3._Financial_Information_Request.docx
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- Attached to
- Simplified Acquisition Base Engineering Requirement (SABER) Federal contract opportunity
- Solicitation number
- FA4801-12-R-0005
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MEMORANDUM FOR WHOM IT MAY CONCERN
FROM: 49 CONS/LGCB
490 First Street, Bldg 29, Ste 2180 Holloman AFB NM, 88330
SUBJECT: Financial Information Request and Release Authorization
| REFERENCES: | (a) | Solicitation FA4801-12-R-0005 |
| (b) | Simplified Acquisition of Base Engineering Requirements (SABER) |
| 1. | Our office is evaluating |
| (NAME OF FIRM) |
of
(FIRM’S ADDRESS, INCLUDING CITY, STATE, AND ZIP CODE)
for possible award of referenced contract. In order to proceed, we must verify the contractor’s financial capability. The firm has provided your name as their bank reference and granted you release, as indicated below, to provide it to the government.
2. Please complete the attached questionnaire and return it by email to TSgt Danielle Greenland (danielle.greenland@holloman.af.mil) at your earliest convenience, but not later than seven (7) calendar days after receipt of this request.
3. All information provided will be FOR OFFICIAL USE ONLY and will not be publicly released. If you need any other information or have any questions, please call me at 575-572-2101. Thank you very much for your assistance.
| JOHN T. SEAMON |
| Contracting Officer |
Attachment Financial Information Sheet
1st Ind, (Name of Offeror’s Firm) (Date)
TO:
(Name of Financial Institution) (Phone # w/Area Code)
|_| I hereby authorize the financial institution to release my information as requested.
SIGNATURE:
BY:
(Print name/title of authorized representative)
FA4801-12-R-0005
FA4801-12-R-0005
Global Power For America
RESPONSIBILITY QUESTIONNAIRE - FINANCIAL
FA4801-12-R-0005
SIMPLIFIED ACQUISITION OF BASE ENGINEERING REQUIREMENTS (SABER)
1. Name of Contractor to whom the following information is applicable:
2. Name of Financial Institution:
3. Address of Financial Institution:
4. How long has the firm been a commercial customer of your bank?
5. What is the type of account and its average* balance? (continue on separate sheet if necessary)
| |_| Checking $ | |_| Checking $ | |
| |_| Savings $ | |_| Savings $ | |
| |_| CD $ | |_| CD $ | |
| |_| Money Market $ | |_| Money Market $ | |
| |_| Other | $ | |
| (SPECIFY TYPE) |
6. Does the company maintain a loan balance at the bank? In what amount?
|_| YES |_| NO $
7. Does the company maintain an unsecured line of credit at the bank? In what amount?
|_| YES |_| NO $
8. What company’s standing with your bank?
|_| Outstanding |_| Excellent |_| Satisfactory |_| Poor |_| Unsatisfactory |_| Other Explain on separate sheet of paper
9. COMMENTS:
I certify that the above information is correct and current as of
(DATE)
SIGNATURE:
BY:
(Print name/title of authorized representative)
DATE:
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