Proposal Attachment 6 Determination of Finance Responsibility

U. S. Department of Homeland Security

FEMA Region IV, Atlanta, GA
3005 Chamblee Tucker Road
Atlanta, GA 30341

(To be completed by the Banking Institution)

DETERMINATION OF FINANCIAL RESPONSIBILITY QUESTIONNAIRE

1. Carefully review the questionnaire of offeror’s responsibility.

2. Banking Information:

Name of Bank:

Date:

Phone #:
Name of Bank Representative:
Signature of Representative:
How long has the vendor been a banking customer:
Is there any reason you would not provide this vendor a loan?

[VENDOR COMPLETES BOTTOM ONLY]

I,

(Name),

(Title) of
(Company Name), hereby
authorize the release of the above information to the Federal Emergency Management Agency, 3005 Chamblee Tucker Rd, Atlanta, Georgia, 30341.
(Signature)
(Date)

www.fema.gov