Project Data Form

SOURCES SOUGHT –EXPERIENCE DATA FORM

For N4008527R0022

INSPECTION, MAINTENANCE, AND CERTIFICATION OF HORIZONTAL LIFELINES

AT NAVAL SUPPORT ACTIVITY (NSA) PORTSMOUTH, PORTSMOUTH, VIRGINIA

Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement. Submit up to five (5) projects. Please limit response to two pages per project. 1.
Contractor Name:

FORMTEXT

2.
Project No. (check one):
FORMCHECKBOX - 1 FORMCHECKBOX - 2 FORMCHECKBOX - 3 FORMCHECKBOX - 4 FORMCHECKBOX - 5 3.
Contract Number:

FORMTEXT

Delivery/Task Order No.:

FORMTEXT

Project Number:

FORMTEXT

Title:

FORMTEXT

Location:

FORMTEXT

4.
Award Date (mm/dd/yy):

FORMTEXT

5.
Final Contract Price:

$ FORMTEXT

Completion Date (mm/dd/yy):

FORMTEXT

(includes all options and mods)
Project is FORMTEXT % complete (as of submission due date) This is the FORMCHECKBOX total project FORMCHECKBOX subcontract price. 6.
Type of work:
FORMCHECKBOX New Construction FORMCHECKBOX Repair FORMCHECKBOX Renovation 7.
Customer/Owner Name:

FORMTEXT

Point of Contact Name/Title: (person with project knowledge)

FORMTEXT

POC Phone Number:

FORMTEXT

POC Email Address:

FORMTEXT

8.
Were you the Prime contractor for this project?

FORMCHECKBOX Yes FORMCHECKBOX No

Were you a subcontractor for this project?

FORMCHECKBOX Yes FORMCHECKBOX No

If subcontractor, who was the Prime contractor?

FORMTEXT

9.
Type of Contract (check all that apply):
FORMCHECKBOX Design-Build FORMCHECKBOX Design-Bid-Build (fully designed project) FORMCHECKBOX Other (explain):

FORMTEXT

If Design-Build, provide the following information:
FORMCHECKBOX Design accomplished in-house
Lead design firm name:

FORMTEXT

Years working together:

FORMTEXT

Address:

FORMTEXT

10. Provide a detailed description of the project:

FORMTEXT

11. Percentage of work you self-performed on this project: FORMTEXT %. Provide a detailed description of the work your firm self-performed on this project:

FORMTEXT

Form may be expanded. Please DO NOT change content of the form.