Encl 4 Experience Data Sheet

Attachment 2 – N40084-26-R-1026

EXPERIENCE DATA SHEET

Individual blocks on this form may be expanded; however, total length should not exceed 1 double-sided (2 single-sided) pages. Project No. (check one) : FORMCHECKBOX PROJECT #1 FORMCHECKBOX PROJECT #2 FORMCHECKBOX PROJECT #3 FORMCHECKBOX PROJECT #4

1. Experience for: FORMCHECKBOX Offeror FORMCHECKBOX Joint-Venture FORMCHECKBOX Other (Explain) 2. Work Performed as: FORMCHECKBOX Prime Contractor FORMCHECKBOX Sub Contractor FORMCHECKBOX Joint Venture FORMCHECKBOX Other (Explain) 5. Type of Relevant Annex(es) for the work indicated in Factor 2 and Price of Work Performed for each Annex/Sub-Annex:

FORMCHECKBOX Spec Item 1604000 3.2.2 Operation, and Maintenance for Granular Activated Carbon (GAC) filtering system (Price of Work: )
FORMCHECKBOX Spec Item 1604000 3.2.1 Operation, and Maintenance for Waste Water Treatment Plant (Price of Work: )
FORMCHECKBOX Spec Item 1502000 3.2.1 Maintenance for Incinerator Plant (Price of Work: )
FORMCHECKBOX Spec Item 1502000 3.2.3.1 Cleaning, disinfection and maintenance for Potable Water Tanks (Price of Work: )
6. Type of Contract/Task Order: (Check ALL that apply)

FORMCHECKBOX Firm-Fixed Price FORMCHECKBOX Cost/Time and Material FORMCHECKBOX Other (explain):

7. Project:

Award Amount of Work Performed: Final Price of Work Performed:

Type of Contract/Task Order: (Check ALL that apply)
FORMCHECKBOX Stand-Alone FORMCHECKBOX Delivery/Task Order (IDIQ) FORMCHECKBOX Other (explain):

9. Provide a detailed description of the project and the relevancy to the project requirements of this RFP. Include how this project meets the definition of a relevant project (size, scope, complexity).

10. Provide a detailed description of what work your firm self-performed on this project:

11. Other Information: