36C24118R0249-012.docx

PAST PERFORMANCE INFORMATION FORM

Provide the following information requested in this format for each of the projects/contracts being described. Projects may be on going and cannot have been competed any later than Five (5) years prior to the solicitation issue date.

OFFEROR: ____________________________________________________________________

CONTRACT NO.________________PROJECT NO.__________________ NAICS: __________

PROJECT TITLE: _______________________________________________________________

LOCATION: __________________________________________________________________

CONTRACTING OFFICER/POC: __________________________________________________

PHONE NO: ________________ E-MAIL ADDRESS: ___________________________

OWNER’S PROJECT MANAGER/POC_____________________________________________

PHONE NO: ________________E-MAIL ADDRESS: ____________________________

ARCHITECT/ENGINEER/POC____________________________________________________

PHONE NO: ___________________ E-MAIL ADDRESS: _________________________

TYPE OF CONTRACT (Negotiated, Design/Build, Design/Bid/Build) _______________________________________

SQUARE FOOTAGE: _______ FOUNDATION TYPE:________

AWARD AMOUNT: $___________________ FINAL AMOUNT: $_______________________

ORIGINAL SCHEDULED COMPLETION DATE:________________________________________________________

ACTUAL COMPLETION DATE: _____________________________________________________________________

OSHA CITATIONS (If Applicable) ____________________________________________________________________

LIST ALL MAJOR SUBCONTRACTORS (W/POC & Phone Numbers)

Modifications: _________________________________________________________________________

DESCRIPTION OF PROJECT – Address project scope of work and explain how the project involved work as a prime contract was technically similar to the project under this solicitation. (May be continued on a blank page, if necessary)

In addition, address the following (May be continued on a blank page, if necessary):

Describe the specific elements of the work performed by your firm ______________________________

Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on this project _______________________________________________

Address any technical areas about this project you consider uniquely relevant to this solicitation _____

· Include a current phone number and email address for point of Contact for Owner/Government agency Contracting Officer and or inspector.