FINANCIAL INSTITUTION REFERENCE SHEET.pdf
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- Solicitation number
- FA441724B0003
About this file
The document provided is a Financial Institution Reference Sheet, which is a form to be included with a contractor's proposal as part of the evaluation for award of the FA4417-24-B-0003 solicitation. The form instructs the contractor to provide contact information for their financial institution and authorizes the release of information about their account balances, loans, lines of credit, payment history, and credit rating to representatives of the 1 SOCONS (Contracting Squadron) at Hurlburt Field, FL. If the contractor is selected as the potential awardee, this form will be sent to their banking institution for completion. The key details provided in the related federal contract opportunity are that it is a solicitation for the Repair of 2nd Floor HVAC B90029 at Hurlburt Field, FL, issued by the Department of the Air Force Special Operations Command.
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FOR OFFICIAL USE ONLY
SOURCE SELECTION SENSITIVE – SEE FAR 3.104
FA4417-24-B-0003
FOR OFFICIAL USE ONLY
SOURCE SELECTION SENSITIVE – SEE FAR 3.104
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor: Include with your proposal 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 award of this solicitation.
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 1 SOCONS (Contracting Squadron), Hurlburt Field FL)
Name/Title Signature/Date
DO NOT HAVE THIS SECTION FILLED OUT. IF YOUR FIRM IS SELECTED AS THE POTENTIAL
AWARDEE, THIS FORM WILL BE SENT TO YOUR BANKING INSTITUTION FOR COMPLETION.
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 or NSF’s? ______________
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
| TO BE FILLED OUT BY CONTRACTOR: |
| TO BE FILLED OUT BY FINANCIAL INSTITUTION: |
File details come from the government source that posted it. Updated .