EXHIBIT A _ FINANCIAL QUESTIONNAIRE.docx

MULTI-FUNCTION MASC N62473-21-R-0020

NAVFAC SW AOR Source Selection

EXHIBIT A

FINANCIAL QUESTIONNAIRE

(To be completed by Financial Institution and submitted by Offeror under Tab 3 of the Price Proposal)

NAVFAC Southwest 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 that you place the completed questionnaire in a sealed envelope showing the return address of the financial institution and forward it to the Offeror shown below. The requested information must be received by the contractor no later than ___________________________

Prospective Contractor for which information is being requested:

Name: ______________________________________________________________ Address: ____________________________________________________________ City/State/Zip: ________________________________________________________ Phone Number: _______________________________________________________ Point of Contact: ______________________________________________________

Signature of Prospective Contractor or Contractor Representative Requesting 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: ______________________

What is the Contractor’s relationship with the bank:

|_||_| Outstanding |_| Satisfactory |_| Other (explain): ________________________________

How long has the Contractor been a client? _______________________________

Signature of person providing the above information

Print Name and Title of person providing the above information

Rev Jan 2018

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

Rev. Apr 2017 2

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY