Att 04_140P8420Q0033_Technical Info Form.pdf

TECHNICAL INFORMATION FORM

(Attachment 04)

Radon Mitigation Point Reyes National Seashore

RFQ No.: 140P8420Q0033

Quoters shall submit the following information:

Quoters Business Name: ___________________________________

Quoters Address: ___________________________________

Quoters DUNS: ___________________________________

Quoters Phone: ___________________________________

Quoters Contact Name: ___________________________________

Quoters Signature: ___________________________________

REQUIRED QUALIFICATION:

Are your proposed key personnel “Qualified Mitigation Personnel” ___________________________ as established in the certification requirements of the National YES or NO answer Radon Proficiency Program (NRPP) or the National Radon Safety Board (NRSB), and as required by the State of California (proof of certification required – attach to your quote).

PAST PERFORMANCE REFERENCES:

Name: ___________________________ Name:____________________________

Business: ___________________________ Business:__________________________

Address: ___________________________ Address:___________________________

Phone Number: ___________________________ Phone Number:_____________________

Name: ___________________________

Business: ___________________________

Address: ___________________________

Phone Number: ___________________________

RFQ No. 140P8420Q0033, Attachment 04, Technical Information Form

LIST OF RELEVANT PROJECTS:

Contract # (if known): ___________________________

Agency/Owner: ___________________________

Contact Person: ___________________________

Phone Number: ___________________________

Amount: ___________________________

Performance Period: ___________________________

Briefly describe how this project is similar in nature and scope to current advertised requirement:

Contract # (if known): ___________________________

Agency/Owner: ___________________________

Contact Person: ___________________________

Phone Number: ___________________________

Amount: ___________________________

Performance Period: ___________________________

Briefly describe how this project is similar in nature and scope to current advertised requirement:

Contract # (if known): ___________________________

Agency/Owner: ___________________________

Contact Person: ___________________________

Phone Number: ___________________________

Amount: ___________________________

Performance Period: ___________________________

Briefly describe how this project is similar in nature and scope to current advertised requirement: