Attachment_2_-_FIRS.pdf

ATTACHMENT #2 FINANCIAL INSTITUTION REFERENCE SHEET RFPP02151700001

FEDERAL BUREAU OF PRISONS FINANCIAL INSTITUTION REFERENCE SHEET

Instrucions to offeror(s): Please fill out and return a reference sheet for each financial institution that you have a business account with. This sheet may be sent to the banking institution(s) in regards to a determination of contractor responsibility as part of the evaluation of offers for contract award.

A: TO BE FILLED OUT BY CONTRACTOR:

ITEM

a COMPANY’S NAME:

b POINT OF CONTACT (POC) NAME:

c POC Phone Number:

I give permission for the information in section B: below regarding my account(s) at your institution to be released to representatives of the Federal Bureau of Prisons, Field Acquisition Office, Grand Prairie, Texas.

Printed Name/Title Signature/Date d FINANCIAL INSTITUTION NAME:

e POC NAME:

f POC TITLE:

g POC PHONE NUMBER:

h POC FAX NUMBER:

B: TO BE FILLED OUT BY FINANCIAL INSTITUTION:

ITEM

Please give amounts as a range when applicable – i.e., low four figures, mid six figures, high five figures, etc.

a AVERAGE MONTHLY BALANCE IN CHECKING:

b AVERAGE MONTHLY BALANCE IN SAVINGS:

c AMOUNT OF ANY CURRENT LOANS:

d AMOUNT OF ANY LINES OF CREDIT:

e ANY LATE PAYMENTS OF NSFs:

f HOW LONG WITH THIS INSTITUTION:

g CREDIT RATING WITH THIS INSTITUTION:

I verify that the information provided above is current as of _____________________________.

Date

Printed Name/Title Signature/Date