JA-10_Financial_Reference_Sheet.pdf
PDF 151 KB Posted
- Attached to
- CH&PP Fire Alarm System Repair Federal contract opportunity
- Solicitation number
- FA5004-15-R-C006
About this file
JA-10 Financial Reference Sheet
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|---|---|---|
| Questions_and_Answers_0001.pdf | ||
| Amendment_0002.pdf | ||
| JA-1_Specifications_(9_July_2015).pdf | ||
| Amendment_0001.pdf | ||
| CHPP_Fire_Alarm_JA_Signed.pdf | ||
| FA5004-15-R-C006.pdf | ||
| JA-9_AF_Form_3065 _Contract_Progress_Report.pdf | ||
| JA-5_Past_Performance_Worksheet.pdf | ||
| JA-7_AF_Form_3000 _Material_Approval_Submittal.pdf | ||
| JA-8_AF_Form_3064 _Contract_Progress_Schedule.pdf | ||
| JA-3_Wage_Determination_Building_and_Heavy_AK1.pdf | ||
| JA-6_AF_Form_66_-_10_Apr_'15.pdf | ||
| JA-4_Past_Performance_Questionnaire.pdf | ||
| JA-1_Specifications.pdf | ||
| JA-2_Drawings_22x34.pdf |
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Text version
ATTACHMENT JA-10
FA5004-15-R-C006
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your proposal a reference sheet for each financial institution that you have a business account with. This sheet may be sent to the banking institution/s in regards to a determination of contractor responsibility as part of the evaluation for award of this solicitation.
TO BE FILLED OUT BY CONTRACTOR:
COMPANY’S NAME: ____________________________________________________________
Point of Contact (POC) Name: _______________________________________________
POC Phone Number: __________________________________________________________
INSTITUTION NAME: __________________________________________________________
POC name: __________________________________________________________________
POC title: _________________________________________________________________
POC phone number: ______________________ fax number: _______________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 354 th
Contracting Squadron, Eielson AFB, Alaska.
Name/Title Signature/Date
DO NOT HAVE THIS SECTION FILLED OUT. IF YOUR FIRM IS SELECTED AS THE POTENTIAL
AWARDEE, THIS FORM WILL BE SENT TO YOUR BANKING INSTITUTION FOR COMPLETION.
TO BE FILLED OUT BY FINANCIAL INSTITUTION:
Please give amounts as a range – i.e. low four figures, mid six figures, etc.
Average monthly balance in checking: ________________
Average monthly balance in savings: _________________
Amount of any current loans: ______________
Amount of any lines of credit: ______________
Any late payments or NSF’s? ______________
How long with this institution: ______________
Credit rating with this institution: ______________
I verify that the information provided above is current as of ____________.
Name/Title Signature/Date
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