Financial Institution Reference Sheet FA670325Q0029.pdf

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Medical Director
Solicitation number
FA670325Q0029
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This document is a Financial Institution Reference Sheet for Solicitation Number FA670325Q0029, dated 17 September 2025, for the 94th Contracting Flight at Dobbins Air Reserve Base in Georgia. The form requires offerors to complete a detailed financial reference sheet for each financial institution with which they have a business account, as part of determining contractor responsibility under FAR 9.104-1. The sheet requests comprehensive financial information from the offeror's bank, including average monthly account balances, current loans, lines of credit, payment history, and credit rating. Failure to fully complete this form may render the quote ineligible for award, and offerors are encouraged to include additional financial documentation such as financial reports or banking statements to support their application.

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FA670325Q0029

Attachment 2

17 September 2025

FINANCIAL INSTITUTION REFERENCE SHEET

Instructions to Offeror: Complete and return a reference sheet for each financial institution that you have a business account with. The Offeror is responsible to send this sheet to their banking institution(s) in regards to a determination of Contractor Responsibility in accordance with FAR 9.104-1, General Standards.

This sheet will be used to evaluate your ability to meet the necessary financial information required by this solicitation located at Dobbins ARB, GA. Failure to complete this sheet may render your quote ineligible for award.

NOTE: Offeror must complete this form in its entirety. Offerors may include additional information i.e. a copy of their latest Financial Report or Banking Statements (Current or previous year).

COMPLETED BY THE OFFEROR

Company’s Name:

Point of Contact (POC) Name:

POC Phone Number:

INSTITUTION’S 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 94th Contracting Flight, 1538 Atlantic Ave. Bldg. 812, Dobbins ARB, GA 30069-4900.

Print Name / Title Signature Date

COMPLETED BY FINANCIAL INSTITUTION:

Request amount 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

Companys Name:
Point of Contact POC Name:
POC Phone Number:
INSTITUTIONS NAME:
POC Name:
POC Title:
POC Phone Number_2:
Fax Number:
Print Name Title:
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:
Name Title:

File details come from the government source that posted it. Updated .