Att 04_140P8420Q0052_Technical Info Form.pdf

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Attached to
Restripe Roads, NPS-CRLA Federal contract opportunity
Solicitation number
140P8420Q0052
Issued by
Department of the Interior National Park Service Pacific West Region

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TECHNICAL INFORMATION FORM

(Attachment 04)

Restripe Roads at Hwy 62, Munson Valley Road, and North Entrance Road Crater Lake National Park

RFQ No.: 140P8420Q0052

Quoters shall submit the following information:

Quoters Business Name: ___________________________________

Quoters Address: ___________________________________

Quoters DUNS: ___________________________________

Quoters Phone: ___________________________________

Quoters Contact Name: ___________________________________

Quoters Signature: ___________________________________

REQUIRED QUALIFICATION:

Does your company hold a current Oregon Construction Contractors Board License? ___________________________ (proof required – attach and include with your quote) YES or NO answer

Are you proposing to use a sub-contractor? ___________________________ YES or NO answer

IF you are proposing to use a sub-contractor, list name of sub(s): _______________________________ (proof required of sub’s current Oregon Construction Contractors Board License)

PAST PERFORMANCE REFERENCES:

Name: ___________________________ Name:____________________________

Business: ___________________________ Business:__________________________

Address: ___________________________ Address:___________________________

Phone Number: ___________________________ Phone Number:_____________________

Name: ___________________________

Business: ___________________________

Address: ___________________________

Phone Number: ___________________________

RFQ No. 140P8420Q0052, 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:

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