Financial Institution Reference Sheet.docx
DOCX document 37 KB Posted
- Solicitation number
- FA465426R0009
About this file
This is a Financial Institution Reference Sheet template for contractor responsibility evaluation related to solicitation FA465425B0001, a project to add/renovate an Aircraft Maintenance Shop (FAC 453) at Grissom Air Reserve Base, Indiana.
The form requires contractors to provide information about their banking relationships and authorizes the U.S. Air Force Air Reserve Command (AFRC) 434 CONF/LGC at Grissom ARB to contact financial institutions directly to verify contractor financial responsibility. Contractors must submit a separate reference sheet for each business account they maintain. The financial institution section requests average monthly balances in checking and savings accounts, current loan amounts, lines of credit, payment history (including any late payments or NSFs), account tenure, and credit rating. All dollar amounts are to be reported in ranges rather than exact figures. The form requires signatures from both the contractor and the financial institution's authorized representative, with the institutional representative certifying the information is current as of the date of signature.
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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 .