Attachment8 1 .doc

42-08-064 ATTACHMENT 8 QUALIFICATION STATEMENT

SEQ CHAPTER \h \r 1

QUALIFICATION STATEMENT

1. Firm Name & Address:

4. Type of Firm:

__A. Small Business __B. Small Disadvantaged __C. Woman-Owned

__D. Other - ________________________

5. Principal Contacts: (List two by Name/Title/Telephone)

6. Present Offices: (Address/Telephone)

7. Corporate Work Experience, Last 5 Years

Note: First, list contracts similar in size(dollars) and scope. Second, list contracts similar in scope only.

Contract No:

Period of Performance:

Dollar Value:

Name of Gov./Commercial Entity:

Contracting Contact Name & Phone:

Technical Rep. Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

Contract No:

Period of Performance:

Contracting Contact Name & Phone:

Brief Description: (Describe the work and how it is similar to NRC’s Requirement.)

The foregoing is a statement of facts

Signature: ____________________________________________ Title: ______________________ Date: _______________

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