Attachment_2_-_Financial_Responsibility_Questionnaire.pdf

FA4855-17-R-0008

Attachment 2

22 May 17

FINANCIAL RESPONSIBILTY QUESTIONNAIRE

SUSPENSE: 21 June 2017 @ 1400hrs MST

Contractor Information:

Name: _______________________________________________________________________________

Address: _______________________________________________________________________________

Point Of Contact (POC): ________________________________________________________________

Phone: ______________________________________________________________________________

Financial Institution:

The above named contractor is competing for contract award at Cannon AFB, NM. As part of the financial responsibility determination required by FAR 9.104-1, please complete the following and return this form to both the contractor listed above and the 27th Special Operations Contracting Squadron (27 SOCONS) points of contact: Brittney Pastore, brittney.pastore.2@us.af.mil and Lt Shane Tittinger, shane.tittinger@us.af.mil not later than 21 June 2017/ 1400 MST.

If you have any questions, please contact the 27 SOCONS POCs listed above. Your assistance is appreciated.

Institution Name: _________________________________________________________________

Address: _________________________________________________________________

POC: _________________________________________________________________

Title: _________________________________________________________________

Phone: _________________________________________________________________

Fax: _________________________________________________________________

1. How long has the account(s) been open?____________________________________________

2. What is the average balance in the account?______________________________

FA4855-17-R-0008

Attachment 2

22 May 17

(ex: high 6 figure, low 8 figure etc.)

3. Does the customer have a credit line available?_______________________________________

If so, what amount of credit is available?________________________________ (ex: high 6 figure, low 7 figure, etc.)

4. Is the customer in good standing?______________________________________

5. Does the institution feel comfortable continuing to support this customer in their business endeavors:_____________________________________________________________________

6. Additional remarks, if any:________________________________________________________

Signature:_____________________________ Date:___________________