Project Experience Questionnaire_Fillable_rev1.pdf

PDF 47 KB Posted Jan 12, 2022

Attached to: Amendment 0001-UPS System Replacement Federal contract opportunity
Solicitation number: 70FBR422Q00000020
Issued by: Federal Emergency Management Agency Region 4

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PROJECT EXPERIENCE QUESTIONNAIRE Attachment 3 (Offerors must complete this form for evaluation purposes)

NAME OF FIRM POINT OF CONTACT

TELEPHONE NO. EMAIL ADDRESS OR FAX

NO.

PRIOR PROJECT EXPERIENCE

(TO BE COMPLETED BY THE OFFEROR - LIST UP TO FIVE (5) INDIVIDUAL PROJECTS)

PROJECT DESCRIPTION

(USE BLANK PAGE IF NECESSARY) CONTRACT/PROJECT

NO.

LOCATION

CONTRACT AMOUNT (ROUND

TO NEAREST DOLLAR)

ORIGINAL FINAL

1. $ $

2. $ $

3. $ $

4. $ $

5. $ $

NAME OF OWNER/AGENCY POINT OF CONTACT TELEPHONE NO. FACSIMILE NO.

ORIGINAL PROJECT DATES WERE YOU A PRIME CONTRACTOR

OR SUBCONTRACTOR?

WERE THERE

CONTRACT

MODIFICATIONS?

(YES/NO)

HOW MANY?

WHO INITIATED

THEM? CLIENT OR

CONTRACTOR? START COMPLETION

WERE THERE ANY

TIME EXTENSIONS?

(YES/NO)

IF SO, INDICATE

TOTAL EXTENDED

DAYS?

WAS THE

SCHEDULE MET?

(YES/NO)

IF NOT, WHAT WAS THE REASON?

(USE BLANK PAGE IF NECESSARY)

HAVE YOU EVER

ENTERED A

DISPUTE? (YES/NO)

IF SO, WHAT WAS THE REASON?

(USE BLANK PAGE IF NECESSARY)

HAVE YOU EVER

BEEN DEFAULTED?

(YES/NO)

IF SO, WHAT WAS THE REASON?

(USE BLANK PAGE IF NECESSARY)

NAME OF FIRMRow1:

POINT OF CONTACTRow1:

TELEPHONE NO:

EMAIL ADDRESS OR FAX NO:

CONTRACTPROJECT NO1:

LOCATION1:

fill_85:

fill_86:

CONTRACTPROJECT NO2:

LOCATION2:

fill_87:

fill_88:

CONTRACTPROJECT NO3:

LOCATION3:

fill_89:

fill_90:

CONTRACTPROJECT NO4:

LOCATION4:

fill_91:

fill_92:

CONTRACTPROJECT NO5:

LOCATION5:

fill_93:

fill_94:

POINT OF CONTACT1:

TELEPHONE NO1:

FACSIMILE NO1:

POINT OF CONTACT2:

TELEPHONE NO2:

FACSIMILE NO2:

POINT OF CONTACT3:

TELEPHONE NO3:

FACSIMILE NO3:

POINT OF CONTACT4:

TELEPHONE NO4:

FACSIMILE NO4:

POINT OF CONTACT5:

TELEPHONE NO5:

FACSIMILE NO5:

COMPLETION1:

WERE YOU A PRIME CONTRACTOR OR SUBCONTRACTOR1:

WERE THERE CONTRACT MODIFICATIONS YESNO1:

HOW MANY1:

WHO INITIATED THEM CLIENT OR CONTRACTOR1:

COMPLETION2:

WERE YOU A PRIME CONTRACTOR OR SUBCONTRACTOR2:

WERE THERE CONTRACT MODIFICATIONS YESNO2:

HOW MANY2:

WHO INITIATED THEM CLIENT OR CONTRACTOR2:

COMPLETION3:

WERE YOU A PRIME CONTRACTOR OR SUBCONTRACTOR3:

WERE THERE CONTRACT MODIFICATIONS YESNO3:

HOW MANY3:

WHO INITIATED THEM CLIENT OR CONTRACTOR3:

COMPLETION4:

WERE YOU A PRIME CONTRACTOR OR SUBCONTRACTOR4:

WERE THERE CONTRACT MODIFICATIONS YESNO4:

HOW MANY4:

WHO INITIATED THEM CLIENT OR CONTRACTOR4:

COMPLETION5:

WERE YOU A PRIME CONTRACTOR OR SUBCONTRACTOR5:

WERE THERE CONTRACT MODIFICATIONS YESNO5:

HOW MANY5:

WHO INITIATED THEM CLIENT OR CONTRACTOR5:

IF SO INDICATE TOTAL EXTENDED DAYS1:

WAS THE SCHEDULE MET YESNO1:

IF NOT WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY1:

IF SO INDICATE TOTAL EXTENDED DAYS2:

WAS THE SCHEDULE MET YESNO2:

IF NOT WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY2:

IF SO INDICATE TOTAL EXTENDED DAYS3:

WAS THE SCHEDULE MET YESNO3:

IF NOT WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY3:

IF SO INDICATE TOTAL EXTENDED DAYS4:

WAS THE SCHEDULE MET YESNO4:

IF NOT WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY4:

IF SO INDICATE TOTAL EXTENDED DAYS5:

WAS THE SCHEDULE MET YESNO5:

IF NOT WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY5:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY1:

HAVE YOU EVER BEEN DEFAULTED YESNO1:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY1_2:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY2:

HAVE YOU EVER BEEN DEFAULTED YESNO2:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY2_2:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY3:

HAVE YOU EVER BEEN DEFAULTED YESNO3:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY3_2:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY4:

HAVE YOU EVER BEEN DEFAULTED YESNO4:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY4_2:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY5:

HAVE YOU EVER BEEN DEFAULTED YESNO5:

IF SO WHAT WAS THE REASON USE BLANK PAGE IF NECESSARY5_2:

Text1:

Text2:

Text3:

Text4:

Text5:

Text6:

Text7:

Text8:

Text9:

Text10:

Start Date1:

Start Date2:

Start Date3:

Start Date4:

Start Date5:

Extensions1:

Extensions2:

Extensions3:

Extensions4:

Extensions5:

Dispute1:

Dispute2:

Dispute3:

Dispute4:

Dispute5:

File details come from the government source that posted it. Updated Jan 12, 2022.