JA09 FTQW235100 Repair Hangar Doors (B1340) Financial Responsibility.pdf
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- Attached to
- FTQW235100 Repair Hangar Door B1340
- Solicitation number
- FTQW235100
About this file
This is a Financial Institution Reference Sheet template used as part of contractor evaluation for federal contract awards at Eielson Air Force Base. The document is designated as source selection information under FAR 2.101 and 3.104.
The form requires contractors to provide authorization for the 354th Contracting Squadron at Eielson AFB to contact their financial institutions and obtain account information for contractor responsibility evaluation purposes. Contractors must complete the top section with company name, point of contact information, and the name of their financial institution(s). The contractor must then authorize the financial institution to release account details by providing a signature and date. The financial institution completes the lower section by providing account balance ranges (in low/mid/high figure ranges), current loan amounts, lines of credit, payment history including any late payments or NSFs, length of banking relationship, and credit rating. The completed surveys must be returned directly from the financial institutions to Ryan Smith at 354CONS.PKA.MonitorConstruction@us.af.mil by the solicitation closing date. This reference sheet is one of potentially multiple sheets required if the contractor maintains business accounts with more than one financial institution.
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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:
Contract
Ryan Smith 354CONS.PKA.MonitorConstruction@us.af.mil
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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