Financial Institution Reference Sheet.docx
DOCX document 37 KB Posted
- Solicitation number
- FA465426R0003
About this file
This is a Financial Institution Reference Sheet template for contractor responsibility evaluation. The document, designated as Attachment 9 to solicitation FA465425B0001 for an Add/Renovate Aircraft Maintenance Shop project at Grissom Air Reserve Base, Indiana, requires contractors to provide banking information from their financial institutions. Contractors must complete contractor-provided sections identifying their company name, point of contact, and phone number, then submit the form to their banking institution(s) for completion. The financial institution completes sections requesting account balance ranges (checking and savings), current loan amounts, lines of credit, payment history, duration of relationship, and credit rating assessment. Completed forms are authorized for release to USAF AFRC 434 CONF/LGC at Grissom Air Reserve Base to support government evaluation of contractor financial responsibility and capability during proposal evaluation.
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Text version
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 .