F. Atch 4 - Deter. of Ktr. Respons..doc

FA4809-10-R-0001

Attachment 4

ATTACHMENT 4

DETERMINATION OF RESPONSIBILITY

In an effort to determine your company responsible, the following items are requested. These are in addition to the General Instructions – Proposal Preparation Instructions contained in Section L.

a. The name of your banking institution(s), to include point(s) of contact and phone number(s).

NOTE: Please ensure you have authorized verbal release of information concerning your accounts. If you have not authorized verbal release of information or your banking institution(s) will not verbally release information, have your banking institution(s) complete the attached form and send via facsimile to 919-722-5424.

b.

The names of at least three (3) suppliers that you do business with, to include points of contact and phone numbers. NOTE: Please ensure you have authorized verbal release of information concerning your accounts. If you have not authorized verbal release of information or your supplier(s) will not verbally release information, have your supplier(s) complete the attached form and send via facsimile to 919-722-5424.

c.

A copy of your most current financial statement prepared by a certified public accountant, to include CPAs notes.

d.

A brief description of your company’s specialty and a statement of how long you have been performing this specialty.

e.

A statement of whether or not your company is incorporated, and if so, when you became incorporated.

f.

A statement of whether or not any of the work will be subcontracted, and if so, the disciplines and the percentages of work to be completed by each party. Your attention is directed to the NAICS code applicable to this solicitation.

g.

A statement of whether or not you will be renting any equipment, and if so, the item(s) to be rented. Provide proof of ability to obtain rental (i.e., rental agreement).

h.

A statement of whether or not any other ongoing government or commercial contracts you have will conflict with this work.

FINANCIAL INFORMATION ON _________________________

(Name of Company)

PROVIDED BY __________________________

(Name of Banking Institution)

a. Are you aware of any problems this company has currently or has had in the past with paying suppliers or employees?

b. Do you have a line of credit established for this company? If so, what is the high to low range? Is it secured or unsecured?

c. Does this company pay in accordance with the payment terms?

d. Additional Comments:

Signature: _______________________ Title: ___________________________ Phone: __________________________ Date: ___________________________

FAX COMPLETED QUESTIONNAIRE TO 919-722-5424

ACCOUNT INFORMATION ON _________________________

(Name of Company)

PROVIDED BY _______________________

(Name of Supplier)

a. How long have you been doing business with this company?

b. What materials do you supply to this company?

c. Does this company pay within your payment terms?

d. What line of credit have you established for this company?

e. Additional Comments:

Signature: _______________________ Title: ___________________________ Phone: __________________________ Date: ___________________________ Fax completed questionnaire to 919-722-5424.