VA250-17-R-0136-034.pdf
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- Attached to
- VISN 10 JOB ORDER CONTRACT IDIQ Federal contract opportunity
- Solicitation number
- VA25017R0136
About this file
This document provides details for a solicitation seeking job order contracting services for the Veterans Integrated Service Network 10. The solicitation will seek to award indefinite delivery/indefinite quantity job order contracts to ten VA medical centers located across Indiana, Michigan, and Ohio. The solicitation will be issued on September 6, 2017 as a 100% set-aside for service-disabled veteran-owned small businesses. The construction IDIQ contracts will have a minimum value of $2,000 and maximum value of $500,000 per task order, with a maximum contract value of $5 million for the base year and each option year. Technical and past performance factors will be significantly more important than price in the source selection process. Awards are expected to be made by December 2017.
VA250-17-R-0136 Attachment 7 - Financial Disclosure.pdf
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104
Indefinite Delivery Indefinite Quantity - Job Order Contract (JOC)
VA261-17-R-0136
ATTACHMENT 7
FINANCIAL QUESTIONNAIRE
OFFEROR INSTRUCTIONS: Please complete below and return as per instructions no later than:
July 9, 2018.
Prospective Contractor for which information is being requested:
Firm Name: ___________________________________________
Address: ___________________________________________
Point of Contact: ___________________________________________
Phone Number: ___________________________________________
Name & Signature of the Person Authorized to request financial information:
Please complete below and return as per instructions no later than: ______________
FINANCIAL INSTITUTION INSTRUCTIONS: The Department of Veterans affairs, Network
Contracting Office 10 is considering the firm listed below for award of a VA contract. In order to be responsive to VA’s needs, it is requested that you complete this questionnaire and place it in a sealed envelope showing return address of the financial institution and forward it to the above-mentioned firm no later July 9, 2018 or you may email as an attachment to (yvonne.demorest@va.gov). Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition
Regulation (15.506) prohibits the release of the names of individuals providing reference information about Offeror’s financial status.
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: ___________________ mailto:yvonne.demorest@va.gov
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