Attachment_05_Capability_Form.pdf

80KSC017R0012- ATTACHMENT 05

CAPABILITY FORM

For

NASA Acquisition for the Supply of Liquefied Natural Gas

CAPABILITY FORM

1. DATE

2. CONTRACT LINE ITEM NUMBER

3. PAGE 1 OF

4. CONTRACTOR/OFFEROR NAME

5. SOLICITATION NUMBER

6. CONTRACT NUMBER

7. CONTRACTOR/OFFEROR ADDRESS

8. CONTRACTOR/OFFEROR PRIMARY CONTACT (Name, Email, Phone, Fax)*

9. CONTRACTOR/OFFEROR ALTERNATE CONTACT (Name, Email, Phone, Fax)

10. PRIMARY PRODUCTION FACILITY 11. ALTERNATE PRODUCTION FACILITY

A. ADDRESS

A. ADDRESS

B. MAXIMUM FIXED STORAGE

B. MAXIMUM FIXED STORAGE

C. MAXIMUM DAILY PRODUCTION

D. MAXIMUM MONTHLY PRODUCTION

C. MAXIMUM DAILY PRODUCTION

D. MAXIMUM MONTHLY PRODUCTION

E. PRODUCTION FACILITY CONTACT

E. PRODUCTION FACILITY CONTACT

12. DISTRIBUTION INFORMATION

A. NUMBER OF TANKER TRAILERS

B. AVERAGE TANKER TRAILER CAPACITY

C. AVERAGE NUMBER OF DRIVERS

In process inspection, end-item inspection, and test verification shall be performed by the Contractor at the Contractor’s facilities to ensure compliance with the contract requirements. The Government shall have access to perform periodic inspections or audits at the Contractor’s, and/or sub-tier supplier, facilities to verify, inspect, and ensure that supplies meet the contract requirements, including calibrations, process control monitoring, drawings and specifications. If production facility is not owned by contractor then attach supply/purchase agreement between contractor and production facility owner.

Printed name and signature of authorized representative:

Name:_______________________________________ Signature:____________________________________

Note 1: The contractor will furnish one point of contact, and an alternate if the contractor so desires, to receive placement of delivery orders by the Government (refer to Block 8).

Note 2: The contractor shall identify the primary production facility that will produce and/or deliver LNG to meet contract line item number requirements. This production facility will be the shipping point used to determine any charges accrued due to the Government’s inability to accept deliveries. The contractor may also identify any alternate facilities that could be used in performance of this contract.