Attachment 5 Financial Institution Sheet 1 page 20210301.pdf
PDF 112 KB Posted
- Attached to
- Installation of Fiber Optic Cable
- Solicitation number
- FA670321R0004
About this file
This document contains a solicitation for the installation of fiber optic cable and manhole/duct system at Dobbins Air Reserve Base in Georgia. The Department of the Air Force Reserve Command is seeking proposals for a firm-fixed-price contract to engineer, furnish, install, label, and test approximately 23,000 feet of single-mode fiber optic communication cables connecting nine buildings on the north side complex and one additional building. The scope of work also includes installing a new manhole in front of Building 401B and pulling 36 existing dark strands of single-mode fiber from a designated handhole into the new manhole and to the Building 401B communications shelter. The solicitation is set aside for small businesses with a size standard of $16.5 million. The contract magnitude is estimated between $500,000 and $1 million. The proposal receipt date is April 5, 2021 and an optional site visit will be held on March 18, 2021.
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Text version
1 March 2021
ATTACHMENT 5
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Please fill out and return 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 solicitation number FA670321R0004, Fiber Optic Installation and Manhole, Dobbins ARB, GA.
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 94th Contracting Flight, Dobbins ARB, GA.
Printed Name/Title Signature/Date
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 of NSFs: ____________________________________ 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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