Attachment 16) Exhibit D - Financial Questionnaire.docx
DOCX document 15 KB Posted
- Solicitation number
- N6247324R3206
About this file
This document is a Financial Questionnaire to be completed by a financial institution for a prospective contractor of a Navy contract. The questionnaire requests information such as the contractor's account details, line of credit, and relationship with the financial institution. This is being requested by the Naval Facilities Engineering Command Southwest (NAVFAC SW) in support of a contract for Base Support Vehicles and Equipment Autobody Painting, Refinishing, and Mechanical Repair Services under Solicitation No. N6247324R3206. The completed questionnaire must be submitted by July 08, 2024 at 2:00 PM Pacific Time prior to contract award.
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Text version
EXHIBIT D
FINANCIAL QUESTIONNAIRE
SOLICITATION NO: N6247324R3206
(To be completed and submitted via secure email by the Financial Institution )
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 submit the completed questionnaire via email to melissa.a.izarelli.civ@uis.navy.mil and christopher.j.jennen.civ@us.navy.mil. The requested information must be received by the contractor no later than July 08, 2024 at 2:00 PM Pacific Time.
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
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