Attachment_11_Financial_Letter_and_Questionnaire.pdf

GSA Greater Southwest Region

U.S. General Services Administration 819 Taylor Street Fort Worth, TX 76102 www.gsa.gov

August 20, 2018

GSA FAS Region 7 819 Taylor Street Fort Worth TX 76102

To Whom It May Concern

Subject: Financial Information Request and Release Authorization (Ref Task ID 180027)

1. Our office is evaluating ____________________________________________________ (Name of Firm)

(Firm’s Address, Including City, State, and Zip Code) for possible award of the reference task identification number. In order to proceed, we must verify the contractor’s financial capability.

2. The contractor will be responsible for providing the Government with the attached Responsibility Questionnaire as of the solicitation closing date. Please provide a point of contact (name, phone number, and e-mail address), so that this information may be verified.

Name

Title

Signature

3. The individual who signs this letter is an executive of the company and is authorized to provide the following release:

I hereby authorize the financial institution to release my information as requested:

Name

Title

Signature

Attachment 11, Financial Letter and Questionnaire

3. All information provided will be FOR OFFICIAL USE ONLY and will not be publicly released. If you need any other information or have any questions, please call me at (817) 850-8341. Thank you for your assistance in this matter.

KENNETH W. MILLER

Contracting Officer

RESPONSIBILITY QUESTIONNAIRE - FINANCIAL

ID07180027

F-16 MISSION TACTICS TRAINER TRAINING SYSTEM SUPPORT CENTER

1. Name of Contractor to whom the following information is applicable:

2. Name of Financial Institution:

3. Address of Financial Institution:

4. How long has the firm been a commercial customer of your bank?

5. What is the type of account and its average *balance? (continue on separate sheet if necessary)

☐Checking $ ☐Checking $

☐Savings $ ☐Savings $

☐CD $ ☐CD $

☐Money Market $ ☐Money Market $

☐Other $

(SPECIFY TYPE)

6. Does the company maintain a loan balance at the bank? In what amount?

☐YES ☐NO $

7. Does the company maintain an unsecured line of credit at the bank? In what amount?

☐YES ☐NO $

8. What company’s standing with your bank?

☐Outstanding ☐Excellent ☐Satisfactory ☐Poor ☐Unsatisfactory ☐Other Explain on separate sheet of paper

9. COMMENTS:

I certify that the above information is correct as of (Date)

SIGNATURE:

BY:

(Print name/title of authorized representative)

DATE: