S02 SOL-Att-03 Financial Disclosure Questionnaire.docx
DOCX document 18 KB Posted
- Solicitation number
- 36C25224R0015
About this file
This document is a Financial Disclosure Questionnaire, which is an attachment to Solicitation 36C25224R0015 for the Department of Veterans Affairs' 2024 Multiple Award Task Order Contract (MATOC) for the Repair Parking lots project at the Iron Mountain VA Medical Center.
The questionnaire instructs the offeror to complete Section A and have their financial institution complete Section B, providing details about the offeror's banking relationship, credit history, and financial standing. This information is considered source selection sensitive and will be used by the VA to evaluate the offeror's financial capability to perform the contract. The solicitation is for a multiple award MATOC, indicating there will be multiple contract awards for this project. No other details about the scope of work, pricing, or procurement schedule are provided in this document.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25224R0015 2024-06-21 FINAL_amended.pdf | ||
| 36C25224R0015 0002.docx | DOCX document | |
| 0002 - Att-11 Contractor Safety and EMR.docx | DOCX document | |
| 585-23-106 sidewalk detail.pdf | ||
| 36C25224R0015 0001.docx | DOCX document | |
| S02 SOL-Att-01-SEED PROJECT SOW Repair Parking Lots.pdf | ||
| S02 SOL_Att09_SEED PROJECT Prints.pdf | ||
| S02 SOL-Att-06 Past Performance Client Questionnaire.docx | DOCX document | |
| S02 SOL_Att08_SEED PROJECT Specs Repair Parking Lots.pdf | ||
| S02 SOL_Att07_SEED PROJECT Pricing Schedule.docx | DOCX document | |
| S02 SOL-Att-11 Contractor Safety and EMR.docx | DOCX document | |
| S02 SOL-Att-04 Contractor Surety Limitations.docx | DOCX document | |
| S02 SOL-Att-12 VAAR 852.219-75 Certification 585-MATOC.docx | DOCX document | |
| S02 SOL-Att-05 Sub-contractor Info Consent.docx | DOCX document | |
| 36C25224R0015_2.docx | DOCX document | |
| S02 SOL-Att-02 Contractor General Information.docx | DOCX document | |
| S02 SOL-Att-10-SEED PROJECT WD MI20240117 06.14.2024.pdf |
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Text version
Multiple Award Task Order Contract (MATOC) 36C25224R0015
Solicitation Attachment 3 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. In order to be responsive to VA’s needs, it is requested that you complete this questionnaire and return to the Offeror such that it is included with their RFP offer. Your comments are considered Source Selection Sensitive; therefore, you are advised that Federal Acquisition Regulation FAR-15.506 prohibits the release of the names of individuals providing reference information about Offeror’s financial status.
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: ______________________________
SOURCE SELECTION SENSITIVE Page 1 of 1 Attachment 3 FAR 2.101 and 3.104-5
File details come from the government source that posted it. Updated .