Attachment G Financial Questionnaire Form.docx

ATTACHMENT G FINANCIAL QUESTIONNAIRE

(To be completed by Financial Institution)

NAVFAC Northwest Silverdale, Washington is currently considering award of a Navy contract to this firm. Prior to award, the Navy requests the financial information listed below with regard to this firm. In order to be responsive to the Navy’s needs, it is requested that you complete this financial questionnaire with regard to this firm. Upon completion of the questionnaire, it is requested you email the completed questionnaire directly to d nancy.m.coffee.civ@us.navy.mil and jason.a.lewis34.civ@us.navy.mil forward it to the Offeror shown below. The requested information must be received by the Government no later than _____.

Prospective Contractor for which information is being requested:

Name:__________________________________________________________________________

Address: ________________________________________________________________________

Phone Number: ________________________ Point of Contact: ________________________

Contractor Email (to be used for completed Financial Questionnaire): _________________________________________________

Signature of Prospective Contractor or Contractor Representative Request Financial Information

Name of Financial Institution: _______________________________________________________

Address:________________________________________________________________________

Phone Number: ____________________________________

Account Number: _______________________________ Type of Account: ________________________

Average Balance Figure: ____________________________ Does the Contractor have a line of credit Yes No

What is the limitation: ___________________ Remaining Balance: _________________

Does the Contractor have any outstanding loans? Yes or No (circle one)

What is the Contractor’s relationship with the bank?

Outstanding Satisfactory Other (explain) ______________________________

Would Financial Institution grant the Contractor additional monies, if necessary? Yes or No (circle one)

Name & title of person providing the above information: _________________________________________

Signature of person providing the above information Date Signed image1.png image2.png