JFSD201151 Financial Institution Reference Sheet.docx
DOCX document 16 KB Posted
- Solicitation number
- FA465924R0005
About this file
This document is a Financial Institution Reference Sheet that the contracting officer may request from the contractor as part of the evaluation for the solicitation FA465924R0005 for the project JFSD201151 Repair (R&M) Bunch Hall Dorm 221 at Grand Forks AFB, ND. The contractor is instructed to fill out the top portion with their company information and then send the form to each of their financial institutions to complete the rest of the form. The financial institution is asked to provide information such as average monthly balances, current loans and lines of credit, any late payments or NSFs, and the contractor's credit rating with the institution. The completed forms are to be returned directly to the contracting officer. The related federal contract opportunity is for a Firm-Fixed-Price Contract to repair Bunch Hall Dorm 221 at Grand Forks AFB, ND, with a site visit scheduled for August 8, 2024. The solicitation is being issued by the 319th Contracting Squadron at Grand Forks Air Force Base, which is part of the Department of the Air Force Air Mobility Command.
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Text version
Financial Institution Reference Sheet
Instructions to Contractor: DO NOT FILL OUT AND SUBMIT THIS FORM UNLESS REQUESTED BY THE CONTRACTING OFFICER. THE CONTRACTING OFFICER RESERVES THE RIGHT TO REQUEST FINANCIAL INFORMATION TO MAKE A CONTRACTOR RESPONSIBILITY DETERMINATION. If requested by Contracting Officer, please fill out and return a reference sheet for each financial institution that you have a business account with. This sheet may be sent to the banking institutions in regard to a determination of contractor responsibility as part of the evaluation for the solicitation: FA465924R0005, for project JFSD201151 Repair (R&M) Bunch Hall Dorm 221 at Grand Forks AFB, ND. The top portion should be completed first, then sent to each financial institution for completion. Please have completed surveys returned directly from the financial institutions to Mrs. Carly J. Larson via email at carly.larson@us.af.mil.
TO BE FILLED OUT BY THE CONTRACTOR:
Company’s Name: _________________________________ Point of Contact (POC) Name: _______________________ POC Phone Number: _______________________________
INSTITUTION NAME: _____________________________
POC Name: _______________________________________ POC Title: ________________________________________ POC Phone Number: ________________________________
I give permission for the following information regarding my account(s) at your institution to be released to representatives of the 319th Contracting Squadron, Grand Forks Air Force Base, ND.
| ____________________________ | _________________________ | |
| 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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