LPTA_Factor_1_form.pdf

AG-0112-S-14-0033

Technical Evaluation Factor 1 Form

Chief Shakes Hot Springs Maintenance

Prime Contractor Information

Technical Experience. (Prime Contractor Only) – Check the box to indicate which Evaluation Factor the description below is intended to represent:

Factor 1

Factor 2

Briefly describe how you meet the Factor:

LPTA Factor 1 Page 1 of 3

Cont:…

PRIME CONTRACTOR INFORMATION:

By completing this form you are representing that the above information is accurate and true as of the date of the signature.

Company Name: ___________________________________

Individuals Name: _________________________________ Phone: ______________________

Signature of Individual: _____________________________ Date: _______________________

E-mail Address: _____________________________________________

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Technical Evaluation Factor 1 Form

Contract Details

List the information for the most recent contracts for this evaluation factor. Provide the survey to the

Owner/Organization. (Surveys must be submitted directly to FS by the Owner/Agency)

Project Name/Number: _________________________________________________

Project Contract Number:____________________________________

Owner/Organization Name: _______________________________________________

Address: ______________________________ P.O. Box/Street

City, State, Zip Code

Owner/Organization Point of Contact: _______________________________________ Name

Owner/Organization Phone Number: _______________________________________

Contract Value: $_________________ Performance Period: ____________________________

Description:

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