ATCH 4 Contractor Financial Questionnaire.doc

Solicitation: FA5000-10-R-0029

Attachment 4, 7 Jun 10

Page 1 of

CONTRACTOR QUESTIONNAIRE & FINANCIAL INFORMATION SHEET

SECTION 1: GENERAL INFORMATION

Company Name: _______________________________________________________________________________ Physical Address: ______________________________________________________________________________ Mailing Address: _______________________________________________________________________________

Phone Number: ________________________________________________________________________________ Owner(s) Name: _______________________________________________________________________________ Phone Number: ________________________________________________________________________________ Management Point of Contact: __________________________________________________________ Phone Number: ____________________________________________________________________________ Alternate Management Point of Contact: ______________________________________________ Phone Number: _____________________________________________________________________________

SECTION 2: FINANCIAL INFORMATION

Information regarding the following items shall be furnished in sufficient detail to allow a full and complete business evaluation.

1. Business Name: ____________________________________________________________________________

2. Type of Business: ___________________________________________________________________________

3. Years in Business: __________________________________________________________________________

4. Individual(s) to contact regarding this proposal:___________________________________________________

3. Date company organized: ____________________________________________________________________

4. Attach a current organizational chart of the company.

5. Name and address of banking facility, point of contact and telephone number. Please notify your banking institution and provide permission to disclose financial information.

Bank Name: ___________________________________________________________________________________ Address: _____________________________________________________________________________________

Phone: _______________________________________________________________________________________

Point of Contact: _______________________________________________________________________________

SECTION 3: REFERENCES

Please list two (2) professional references and separately provide two (2) letters of recommendation from these references.

1. ____________________________________________________________________________________________________________________________________________________________________________

2. ____________________________________________________________________________________________________________________________________________________________________________

SECTION 4: PROFESSIONAL HISTORY

Please list and provide documentation of two (2) professional awards, if available.

1. ____________________________________________________________________________________________________________________________________________________________________________

2. ____________________________________________________________________________________________________________________________________________________________________________