S02 Att08 Financial Disclosure Questionnaire.docx
DOCX document 19 KB Posted
- Solicitation number
- 36C25226R0038
About this file
This is a Financial Disclosure Questionnaire template designed for use in the source selection process for federal contract opportunities. The document is divided into two sections: Section A requires the prospective contractor to provide basic company information (name, address, contact details, and authorized representative signature) and submit the form to their financial institution for completion; Section B instructs the financial institution to provide detailed financial information about the contractor, including banking details, account type and average balance, line of credit availability and unused balance, relationship rating with the bank, length of client relationship, and most recent credit rating information with the date and rating source. The questionnaire emphasizes that all financial information and the identities of individuals providing reference information are source selection sensitive and prohibited from release.
This questionnaire is a required attachment (Attachment 8) for the pre-solicitation notice for solicitation 36C25226R0038, a 100% small-business set-aside IDIQ contract for asbestos abatement and lead-based paint removal services at the Hines VA Hospital in Hines, Illinois. The contract is classified under NAICS Code 562910 (Remediation Services) with a small-business size limit of $25 million, and prospective contractors must be registered in the System for Award Management (SAM) database to be eligible for evaluation and award. The full solicitation is scheduled to be posted to SAM.gov on or about March 20, 2026, with two mandatory site visits to follow.
View the file
Other files
Show all 19
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
SOURCE SELECTION SENSITIVE
Solicitation Attachment 8 Financial Disclosure Questionnaire
OFFEROR INSTRUCTIONS: Section A shall be completed by Offeror and submitted to Financial Institution requesting they complete and return to Offeror and included in the RFP offer.
SECTION A:
Prospective Contractor for which information is being requested:
| Contractor Name: | __________________________________________________________________ | ||
| Address: | __________________________________________________________________ | ||
| Phone Number: | __________________________________________________________________ | ||
| e-mail: | __________________________________________________________________ | ||
| Name & Signature of the Person | ______________________________________________ | ||
| Authorized to request financial information: | ______________________________________________ |
FINANCIAL INSTITUTION INSTRUCTIONS: The Department of Veterans Affairs, Network Contracting Office 12 is considering the firm listed above for award of a VA contract. To be responsive to VA’s needs, it is requested that you complete this questionnaire and return it to the Offeror such that it is included with their RFP offer. Your comments are considered Source Selection Sensitive; the release of the names of individuals providing reference information about Offeror’s financial status is prohibited
SECTION B:
Banking Institution: _________________________________________
Account number: ______________ Type of account:______________ Average balance:_____________
Do they have a Line of Credit? [ ] Yes [ ] No
What is their limitation: ________________________ Unused Balance: _________________
Relationship with the bank: [ ] Outstanding [ ] Satisfactory [ ] Other: __________________
How long have they been a client: ______________________________
What is their most recent credit rating: ______________________________
Date of most recent credit rating: ______________________________
Credit rating prepared by: ______________________________
Signature of Provider/Title: ______________________________
Date: ______________________________
Solicitation 36C25226R00038 Page 2 of 2 578-26-004 IDIQ Abatement Services Attachment 08 Financial Disclosure
File details come from the government source that posted it. Updated .