Attachment_D_RFP.docx

ATTACHMENT D of the RFP

DATE

MEMORANDUM FOR WHOM IT MAY CONCERN

FROM: NAVFAC MW, PWD GREAT LAKES

2625 Ray Street, Building 2016 Naval Station, Great Lakes, IL 60088

SUBJECT: Financial Information Request and Release Authorization

REFERENCES: (a) Solicitation N40083-14-R-3213, Roofing Multiple Award Construction Contract (Roofing MACC), Naval Station, Great Lakes, IL

1. Our office is evaluating _______________________________________________________

(NAME OF FIRM)

Of ____________________________________________________________________________

(FIRM’S ADDRESS, INCLUDING CITY, STATE AND ZIP CODE)

For possible award of contract for (Reference (a)). In order to proceed, we must verify the contractor’s financial capability. The firm has provided your name as their bank reference and grated you release, as indicated below, to provide this information to the Government.

2. Please complete the attached questionnaire and return it by fax (847-688-3689) or email to the Contract Specialist (shawn.j.wales1@navy.mil) at your earliest convenience, but not later than seven (7) calendar days after receipt of this request.

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 847-688-5395, Ext. 249. Thank you for your assistance.

Attachment:

Financial Information Sheet

|_| I hereby authorize the financial institution to release my information as requested.

SIGNATURE: _____________________________________________________________________

BY: _______________________________________________________________________________ (Print name/title of authorized representative)

RESPONSIBILITY QUESTIONNAIRE – FINANCIAL

N40083-14-R-3213

IDIQ ROOFING MACC

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)

6. Does the company maintain a loan balance at the bank? If so, in what amount?

|_| YES |_| NO $

7. Does the company maintain an unsecured line of credit at the bank? If so, in what amount?

|_| YES |_| NO $

8. What is the 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 and current as of

(DATE)

SIGNATURE:

BY:

(Print name/title of authorized representative)

DATE: