Attachment 4 - Financial Reference.docx
DOCX document 17 KB Posted
- Attached to
- Paving Multiple Award Construction Contract (MACC) IDIQ Federal contract opportunity
- Solicitation number
- FA706023R0003
About this file
This document contains an attachment and related federal contract opportunity. The attachment provides a financial reference sheet template for contractors to submit with proposals. It requests information on company name, points of contact, account numbers, and permission to release financial information to the 11th Contracting Squadron at Joint Base Anacostia-Bolling. The top section is for contractors to fill out, while the bottom is for financial institutions.
The related federal contract opportunity is a pre-solicitation notice for a multiple award construction contract indefinite delivery/indefinite quantity contract with a total ceiling of $100 million. The North American Industry Classification System code is 237310 for highway, street, and bridge construction. The solicitation will provide construction services for paving projects over a five-year period at Joint Base Anacostia-Bolling. The solicitation number is FA706023R0003 and is anticipated to be issued within 15 days as a competitive 8(a) small business set-aside with five anticipated awards. Evaluation will be based on technical capability and past performance.
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Text version
FA706023R0003
Attachment 4
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 email address:____________________________________________________________ POC title: ____________________________________________________________________ POC phone number: ______________________ fax number: ___________________________ Account #_______________________________
I give permission for the following information regarding my account/s at your institution to be released to representatives of the 11th Contracting Squadron, Joint Base Anacostia-Bolling, DC.
| _____________________________________ | _____________________________________ | |
| 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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