FA486110RA200_NELLIS_MACC_Atch25 Financial Information Request.docx

MEMORANDUM FOR WHOM IT MAY CONCERN

FROM: 99 CONS/LGCA

5865 Swaab Blvd, Bldg 588 Nellis AFB NV 89191-7063

SUBJECT: Financial Information Request and Release Authorization

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 fax (702-652-2531) or email to me (jacquelyn.buky@nellis.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 702-652-2531. Thank you very much for your assistance.

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 insitution to release my information as requested.

SIGNATURE:

BY:

(Print name/title of authorized representative)

DEPARTMENT OF THE AIR FORCE

99TH CONTRACTING SQUADRON (ACC)

NELLIS AIR FORCE BASE, NEVADA

Global Power For America

RESPONSIBILITY QUESTIONNAIRE - FINANCIAL

FA4861-10-R-A200

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)

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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