Attch_2_Financial_Information_Request.docx

28 Mar 13

MEMORANDUM FOR WHOM IT MAY CONCERN

FROM: 379ECONS/LGCC

Al Udeid Air Base, Qatar

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 email to Robert Lieder at (robert.lieder@auab.afcent.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 email Robert Lieder at the address above. 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 institution to release my information as requested.

SIGNATURE:

BY:

(Print name/title of authorized representative)

RESPONSIBILITY QUESTIONNAIRE - FINANCIAL

FA5702-14-R-0004

FIRM FIXED PRICE CONTRACT (FFP)

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: