Financial Institution Reference Sheet.docx
DOCX document 37 KB Posted
- Solicitation number
- FA465426R0004
About this file
This is a Financial Institution Reference Sheet template to be completed by contractors as part of the responsibility determination process for solicitation FA465425B0001. The form is used to verify a contractor's financial stability and creditworthiness by collecting banking information directly from the contractor's financial institutions. Contractors must submit a completed reference sheet for each business account they maintain, which will be sent to their banking institution(s) with the contractor's permission for verification purposes.
The form requires contractors to provide their company name and point of contact information, along with details for each financial institution including the institution name, POC, phone number, and fax number. Financial institutions are instructed to provide account information in ranges rather than specific figures, 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 completed forms must be signed and dated by both the contractor and the financial institution representative to certify the information is current as of the date provided.
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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 .