Attach_03_Technical_Information_Form.docx

RFQ No. 140P8422Q0129, Attachment 3, Technical Information Form

TECHNICAL INFORMATION FORM

(Attachment 3)

Removal of Underground Fuel Storage Tank Oregon Caves National Monument & Preserve RFQ No.: 140P8422Q0129

Quoters shall submit the following information:

Quoters Business Name: ___________________________________

Quoters Address: ___________________________________

Quoters UEI: ___________________________________

Quoters Phone: ___________________________________

Quoters Contact Name: ___________________________________

Quoters Signature: ___________________________________

CONTRACTOR’S PROPOSED TEAM:

Do you plan to self-perform all of the work? ___________________________ YES or NO answer

Are you proposing to use a subcontractor? ___________________________

List any proposed subcontractor(s) and indicate what key trade they may be assigned to perform:

If you are proposing to use a subcontractor, describe what work activities you plan to self-perform:

REQUIRED QUALIFICATION:

Is your firm a OR Licensed Contractor such as? _______________________

☐ proof of OR license is required – include with your quote

IF you are proposing to use a subcontractor for any of the work:

☐ proof of proposed sub’s current applicable OR license is required – include with your quote

☐ proof of prime contractor’s OR Contractor State License is required – include with your quote

SCHEDULE:

☐ Attach a proposed schedule for this project with your quote, such as Gantt chart or similar format showing major elements of work with start date, end date, and sequence; and the identification of the critical path activities.

LIST OF RELEVANT EXPERIENCE (LIST OF PROJECTS) & PAST PERFORMANCE REFERENCES:

1) Project Title: ___________________________ Contract # (if known): ______________

Agency/Owner: ___________________________ $ Amount: _______________________

Performance Period: ___________________________

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

Past Performance Reference (Name & Title): _____________________________________________________

Phone Number: ________________________________ Email: ________________________________________

2) Project Title: ___________________________ Contract # (if known): ______________________

Agency/Owner: ___________________________ $ Amount: ____________________________________

Performance Period: ___________________________

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

Past Performance Reference (Name & Title): _____________________________________________________

Phone Number: __________________________________ Email: _______________________________________

3) Project Title: _______________________________ Contract # (if known): ______________________

Agency/Owner: _____________________________ $ Amount: ___________________________________

Performance Period: _____________________________________

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

Past Performance Reference (Name & Title): _____________________________________________________

Phone Number: _____________________________________ Email: __________________________________

SAFETY RECORD

☐ Submit an overview of your company’s general Construction Safety Program – attach with your quote

NARRATIVE – in the space below briefly provide an assessment of the safety risks associated with this construction project, and discuss any changes to your company’s Construction Safety Program required to address your assessment of the project risk:

☐ Submit a copy of your company’s OSHA 300A logs for the previous three calendar years.

☐ If proposing to use a subcontractor for the roofing work, additionally submit a copy of your proposed roofing subcontractor’s OSHA 300A logs for the previous three calendar years.