Financial Institution Reference Sheet.docx
DOCX document 17 KB Posted
- Attached to
- B1305 and B1355 Water Heater Renovation
- Solicitation number
- FA442722R0006
About this file
This document contains a federal contract solicitation and financial institution reference sheet template. The solicitation is for B1305 and B1355 Water Heater Renovation services at a magnitude between $500,000 to $1,000,000. This is a firm-fixed price, Service Disabled Veteran Owned Small Business set-aside issued by the Department of the Air Force Air Mobility Command. The closing date for questions is June 24th, 2022, with answers posted to SAM.gov. A site visit will be held per FAR 52.236-27 Alt 1. The NAICS code is 238220.
The financial institution reference sheet template requires contractors to provide banking references to be checked as part of the responsibility determination process. Contractors must fill in company and point of contact information for each bank, and authorize the release of information including average account balances, loans, lines of credit, late or returned payments, credit history, and time with the institution. Banks will then verify the data provided on the form.
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Other files
| File | Type | Posted |
|---|---|---|
| 1355_1.pdf | ||
| 1305_2_3.pdf | ||
| 1355_3.pdf | ||
| 1305_1.pdf | ||
| 1355_2.pdf | ||
| Solicitation Amendment FA442722R00060003 SF 30.pdf | ||
| Attendance Sheet 21 June 2022.pdf | ||
| Solicitation Amendment FA442722R00060002 SF 30_signed.pdf | ||
| Questions and Answers.pdf | ||
| Solicitation Amendment FA442722R00060001 SF 30.pdf | ||
| B1305 Vicinity map.pdf | ||
| B1355 Vicinity map.pdf | ||
| Solicitation - FA442722R0006.pdf | ||
| Past Performance Questionnaire (PPQ).docx | DOCX document | |
| SOW XDAT 21-1020 REPAIR DHW B1355 Rev1.docx | DOCX document | |
| SOW XDAT 21-1073 REPAIR DHW B1305 Rev1.docx | DOCX document |
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Text version
Financial Institution Reference Sheet
Instructions to Contractor: Complete 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.
TO BE FILLED OUT BY CONTRACTOR:
COMPANY’S NAME: ____________________________________________________________
Point of Contact (POC) Name: ______________________________________________________ POC Phone Number: ______________________________________________________________
INSTITUTION NAME: ___________________________________________________________
POC name: _____________________________________________________________________ POC title: ______________________________________________________________________ POC email address: ______________________________________________________________ POC phone number: ______________________ fax number: ___________________________
I give permission for the following information regarding my account/s at your institution to be released to TSgt Wendell Gibson and Mr. Rory Gardner of the 60th Contracting Squadron, Travis AFB, California.
Name/Title Signature/Date DO NOT HAVE THIS SECTION FILLED OUT. 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
File details come from the government source that posted it. Updated .