Atch_20_Financial_Information_Request.pdf

DEPARTMENT OF THE AIR FORCE

49TH CONTRACTING SQUADRON (ACC)

HOLLOMAN AIR FORCE BASE, NM

MEMORANDUM FOR WHOM IT MAY CONCERN

FROM: 49 CONS/PKB

490 First Street, Ste 2111, Bldg 29 Holloman AFB NM 88330-8277

SUBJECT: Financial Information Request and Release Authorization

REFERENCES: (a) Solicitation FA480118R1004

(b) Multiple Award Construction Contract (MACC)

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 with your proposal.

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 575-572-3048. Thank you very much for your assistance.

ANTHONY D. OVERBAY

Contracting Officer Attachment 20 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 insitution to release my information as requested.

SIGNATURE:

BY:

(Print name/title of authorized representative)

RESPONSIBILITY QUESTIONNAIRE - FINANCIAL

FA480118R1004

MULTIPLE AWARD CONSTRUCTION CONTRACT (MACC)

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 acount 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: