Attachment_21_-_Financial_Information_Request.docx

5 Dec 2016

MEMORANDUM FOR WHOM IT MAY CONCERN

FROM: 56 CONS/LGCB

14100 W. Eagle Street, Bldg 26 Luke AFB AZ 85309-1217

SUBJECT: Financial Information Request and Release Authorization

REFERENCE: Solicitation #FA4887-17-R-0001, Mechanical Indefinite Delivery Indefinite Quantity (IDIQ) Contract, Luke Air Force Base, Arizona

of

(FIRM’S ADDRESS, INCLUDING CITY, STATE, AND ZIP CODE)

for possible award of referenced contract. We are required to verify the contractor’s financial capability. The firm has provided your name as their bank reference, and has granted you release information requested below to the Government.

2. Please complete the attached questionnaire and return via fax (623)-856-3438 or email: julie.kocinski@us.af.mil, no later than seven calendar days after receipt of this request.

3. All information provided will be FOR OFFICIAL USE ONLY and will not be publicly released. For questions or concerns, please contact Ms. Kocinski at 623-856-2767.

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

56TH CONTRACTING SQUADRON (AETC)

LUKE AIR FORCE BASE, ARIZONA

Attachment 21

RESPONSIBILITY QUESTIONNAIRE - FINANCIAL

FA4887-17-R-0001

Mechanical Indefinite Delivery Indefinite Quantity (IDIQ) Contract, Luke Air Force Base, Arizona

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. Please indicate the account type and provide the average balance: (continue on separate sheet if necessary)

6. Does the company maintain a loan balance at the bank? Please write in the dollar value/amount?

|_| YES |_| NO $

7. Does the company maintain an unsecured line of credit at the bank? Please write in the dollar value/amount?

|_| YES |_| NO $

8. What is the company’s current 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:

Attachment 21 image1.png