Financial Responsability Verification.pdf
PDF 260 KB Posted
- Attached to
- FTQW 20 0504 2 CHPP Electrical Upgrades
- Solicitation number
- FTQW2005042
About this file
This is a Financial Institution Reference Sheet template used as part of source selection evaluation for a federal contract opportunity at Eielson AFB.
The form requires contractors to provide financial references from banking institutions where they maintain business accounts. Contractors must complete the top section with their company name, point of contact information, and the financial institution details. The contractor must authorize release of account information to the 354th Contracting Squadron at Eielson AFB Alaska. Financial institutions receiving the form must complete the bottom section providing account information in ranges (low four figures, mid six figures, etc.), including average monthly checking and savings balances, current loan amounts, lines of credit, history of late payments or NSFs, duration of the banking relationship, and the institution's credit rating assessment. All financial institution responses must be returned directly to Ryan Smith at ryan.smith.186@us.af.mil by the solicitation closing date of February 18, 2026. The form is designated as Source Selection Information under FAR 2.101 and 3.104.
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Text version
Source Selection Information -- See FAR 2.101 and 3.104
Source Selection Information -- See FAR 2.101 and 3.104
FINANCIAL INSTITUTION REFERENCE SHEET
Instructions to Contractor:
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 th Contracting , AFB .
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
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