JA07 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 for contractor financial verification as part of source selection evaluation for a federal contract opportunity at Eielson Air Force Base.
The form requires contractors to provide their company information and designate a point of contact, then authorize release of financial account information to the 354th Contracting Squadron at Eielson AFB. Contractors must submit a completed reference sheet for each financial institution where they maintain a business account. The financial institutions are required to complete the reverse side of the form, 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, any late payments or non-sufficient funds (NSFs), length of relationship with the institution, and credit rating. Completed surveys must be returned directly from the financial institutions to Ryan Smith via email at 354CONS.PKA.MonitorConstruction@us.af.mil by the solicitation closing date. This template is classified as source selection information per FAR 2.101 and 3.104 and serves as an evaluation tool for assessing contractor financial responsibility and capability to perform the contract.
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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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