N69450-13-Q-3083_ATTACHMENT_7_Responsibility__Form.pdf

ATTACHMENT 7

N69450‐13‐Q‐3083 Base wide Refuse Services

NAS Fort Worth JRB

RESPONSIBILITY EVALUATION FORM

Offeror: ____________________________________________ Date: __________________

A. NAMES OF OFFICERS, OWNERS OR PARTNERS:

President: ________________________ Vice President: __________________________ Secretary: ________________________ Treasurer:_______________________________ Owner or Partners: ___________________________________________________________

B. PERSONS AUTHORIZED TO SIGN OFFERS, MODIFICATIONS AND CONTRACT

FOR COMPANY

Name: __________________________ Official Capacity: ________________________

C. BANKING REFERENCES (Please notify the Point of Contact that we will be contacting.)

Name of Bank: _____________________ Point of Contact: _________________________ Address: __________________________ Phone: _________________________________ Email:_________________________________ Checking Account: _____________ Savings Account: ____________ Loan:_____________

GOVERNMENT USE

Date account opened: _________________________________________________________ Ratings: __________________ Amount: _______________ Balance: __________________ Comments:_____________________________________________________________________

D. CREDIT REFERENCES (Please notify the Point of Contact that we will be contacting.)

Firm Name: _______________________ Address: _______________________________ Point of Contact: _____________________ Phone: _________________________________ Email: _______________________________________

GOVERNMENT USE

Date account opened: _________________________________________________________ Ratings: __________________ Amount: _______________ Balance: __________________ Comments:_____________________________________________________________________