Exhibit_C_Form_N_Experience_Statement.doc

Ex C Form N (Rev. 1, 9/22/08) Exhibit C Form N – Experience Statement October 1, 2018

EXHIBIT “C”

FORM N

EXPERIENCE STATEMENT

PN: This form may not be required if a full bidder pre‑qualification has been performed and the data is up to date. If there has been no prequalification, use the “Contractor Questionnaire” and substitute this tailored Form N for the experience statement in that form.

The Bidder submits the following statement as to its experience qualifications. Specifically, the bidder shall include work experience related to the drilling and installation of large volume production wells within tuff and/or basalt formations. In the case of a joint venture, separate forms will be submitted for previous experience of the joint venture and the experience of each party of the joint venture.

1.

This company has been engaged in the contracting business under its present business name for years.

2.

Experience in work of a nature similar in type and magnitude to that set forth in the Request for Proposal extends over a period of years.

3.

All awarded contracts have been satisfactorily completed, except as follows (Name any and all exceptions and reasons therefore, attaching additional pages if necessary):

PN: In the following item, include the required number of years in the space provided.

4.

The following contracts, covering work similar in type and magnitude to that set forth in the Request for Proposal, have been satisfactorily completed within the last three years.

NOTES:

Column completion notes:

Work Description:

Describe work scope and then indicate if prime or subcontract.

Start/Stop:

Provide starting date and actual/forecast completion by month/year format (e.g., Jan 2006/Sep 2007).

Schedule and Budget State either “over”, “on”, or “under” schedule and budget.

THIS FORM IS FOR EVALUATION PURPOSES AND WILL NOT BE PART OF THE SUBCONTRACT.

PR# RFP-0000186