Financial Institution Reference Sheet.docx
DOCX document 35 KB Posted
- Solicitation number
- FA465426R0001
About this file
This is a Financial Institution Reference Sheet template for contractor responsibility evaluation purposes. The form is Attachment 9 to solicitation FA465425B0001 for Project CTGB 162017, Add/Renovate Aircraft Maintenance Shop FAC 453 at Grissom Air Reserve Base, Indiana. Contractors are required to complete and submit one reference sheet for each financial institution with which they maintain a business account. The completed forms may be forwarded to banking institutions by the USAF AFRC 434 CONF/LGC at Grissom ARB to assess contractor financial responsibility and capability.
The form requires contractors to provide company name, point of contact information, and institution details. Financial institutions must complete the second section by providing account balance ranges (checking, savings), current loan amounts, lines of credit, payment history (late payments or NSFs), account tenure, and credit rating assessment. All information must be current as of the certification date and verified by an authorized financial institution representative. This reference sheet serves as a financial capability assessment tool during the contractor evaluation process for the stated acquisition.
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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 .