JA 07 Financial Responsibility DFAC Roof.pdf
PDF 249 KB Posted
- Attached to
- FTQW261103 Repair DFAC Roof
- Solicitation number
- FTQW261103
About this file
This is a Financial Institution Reference Sheet template used as a source selection evaluation document for federal contracting purposes. The form is associated with solicitation FA500426B0002 for the 354th Contracting Squadron at Eielson Air Force Base in Alaska, with a submission deadline of 21 April 2026 at 1400 hours. The contracting office contact is 354CONS.PKA.MonitorConstruction@us.af.mil.
The form requires contractors to provide authorization for the government to contact their financial institutions and verify financial responsibility information. Contractors must complete the top section with their company name, point of contact details, and the financial institution's information. The financial institution then completes the lower section, providing information in ranges regarding the contractor's average monthly checking and savings balances, current loans, lines of credit, payment history (including any late payments or NSFs), tenure with the institution, and credit rating. All financial institution responses must be returned directly to 354 CONS via email by the solicitation closing date. This template is used to assess contractor financial capability and responsibility as part of the source selection evaluation process.
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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 for solicitation
FA500426B0002
354 CONS
354CONS.PKA.MonitorConstruction@us.af.mil 21 April 2026 at 1400 hrs
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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