36C25919R0092-007.docx

CONSTRUCTION EXPERIENCE PROJECT DATA SHEET

VA259-16-R-0048, Water Softener

Project No. (check one) : |_| CON #1 |_| CON #2 |_| CON #3 |_| CON #4 |_| CON #5

1. Experience for: |_| Offeror |_| Joint-Venture |_| Other (Explain)

Firm Name:

Address:

Phone Number:

DUNS Number:

Point of Contact: Contact Phone Number:

2. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other (Explain)

Percent of project work performed:

If subcontractor, who was prime (Name/Phone #):

3. Contract Number: Delivery/Task Order Number:

Title:

Location:

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

5. Type of work:

|_| New Construction |_| Renovation |_| Repair |_| Alteration |_| Other (explain):

6. Type of Contract/Task Order: (Check ALL that apply)

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

7. Construction Project:

Award Amount: Final Price:

Type of Contract/Task Order: (Check ALL that apply)

|_| Design-Build |_| Design-Bid-Build |_| Delivery/Task Order (IDIQ) |_| Other (explain):

If Design-Build, identify the Lead Design Firm:______________________________________________

8. Customer/Owner Name:

Point of Contact (POC): POC Phone Number:

FAX Number: POC E-mail address:

9. Provide a detailed description of the project and the relevancy to the project requirements of this RFP (i.e.: unique features, square footage, construction methods), including any sustainable features or USGBC LEED certifications. If design-build, include a description of the design-effort.

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

11. Other Information: