Financial Institution Reference Sheet.docx

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Attached to
Repair Fire Protection Systems - Project 27-5000: Grissom ARB, IN
Solicitation number
FA465426R0011
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This is a Financial Institution Reference Sheet template used by the U.S. Air Force Reserve Command to assess contractor responsibility as part of the evaluation process for solicitation FA465425B0001, related to an Add/Renovate Aircraft Maintenance Shop project at Grissom Air Reserve Base, Indiana. The form requires contractors to provide financial institution reference information, including the name and contact details for each banking institution where the contractor maintains business accounts. Contractors must authorize the release of their account information to USAF AFRC 434 CONF/LGC at Grissom ARB for verification purposes.

The financial institution is required to complete the reverse side of the form by providing account information in ranges, including average monthly balances in checking and savings accounts, current loan amounts, lines of credit, payment history, length of relationship with the institution, and credit rating. The form serves as a document to verify the contractor's financial stability and creditworthiness during the pre-award responsibility determination phase. Both the contractor and the financial institution representative must sign and date the form to certify that the information provided is current and accurate.

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19 JAN 2025

Attachment 9

FA465425B0001

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 FA465425B0001, Project CTGB 162017, Add/Renovate Aircraft Maintenance Shop FAC 453, Grissom Air Reserve Base, IN

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 USAF AFRC 434 CONF/LGC, Grissom ARB, IN.

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

File details come from the government source that posted it. Updated .