Attachment 1: Sources Sought-Contractor Information Form

8261351410970SMEDLEY D. BUTLER, OKINAWA, JAPAN

00SMEDLEY D. BUTLER, OKINAWA, JAPAN

178625525514300017862552807335001786255306641500
SOURCES SOUGHT – CONTRACTOR INFORMATION FORM for Facility Weight Handling Equipment (WHE) Maintenance and Repair Services at Marine Corps Installation Pacific (MCI-PAC) Camp Smedley D. Butler Okinawa, Japan

Use this form to provide contractor's general information. Please limit response to one page. The box at the bottom of this form may be used to clarify any requested information.

1. Contractor Information:

Firm Name: Address:
SAM Unique Entity ID# / CAGE CODE
Name of POC for firm:
Phone Number of POC:Email of POC:
2. This space may be used to provide any additional information that is relevant:

2755265199961500321246519996150036696651999615004126865199961500458406519996150057912003200400004809490346265500574548034626550023101303648710003839210364363000279781044259500041211504822190004913630482219000412115050355500049136305035550008077205794375002462530579437500807720600138500

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM for

Facility Weight Handling Equipment (WHE) Maintenance and Repair Services at Marine Corps Installation Pacific (MCI-PAC) Camp Smedley D. Butler Okinawa, Japan

Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement. Submit up to 5 projects. Please limit response to two pages per project.

1. Contractor Name:

2. Project No. (check one):- 1- 2- 3- 4- 5
3.Contract Number:Delivery/Task Order No.:
Project Number:
Title: Location:
4. Award Date (mm/dd/yy): Completion Date (mm/dd/yy): Project is % complete (on submission due date) 5.Final Contract Price:$ (incl. all options and mods)
This is thetotal projectsubcontract price.
6.Type of work:Facilities Support
7.Customer/Owner Name: Point of Contact Name/Title:
(person with project knowledge)
POC Phone Number:POC Email Address:
8.Were you the Prime contractor for this project?YesNo Were you a subcontractor for this project?YesNo If subcontractor, who was the Prime contractor?
9. Type of Contract (check all that apply):
Firm Fixed-Price (FFP) Indefinite Delivery / Indefinite Quantity (IDIQ) Other (explain):
If partnership, provide the following information:
Partner firm name:Years working together:
Address:

10. Narrative Description of the Project:

11. Percentage of work you self-performed on this project:%. Explain work self-performed: