Attachment_07_-_Corporate_Experience_Questionnaire_1.docx

Attachment 07 – Corporate Experience Questionnaire Please complete this form for three (3) projects conducted in the past five (5) years that are similar in size and scope to the services described in the Statement of Work.

Customer No. : Comment by Dhir, Neha (NIH/OD/ORF) [C]: ? Comment by Fratangelo, John (NIH/OD/ORF) [E]: We want 3 of these filled out by each offeror. Comment by Fratangelo, John (NIH/OD/ORF) [E]:

Client/Company/Agency Name: ___________________________________

Address Line 1: _____________________________________________

Address Line 2: _____________________________________________

Contract Type: ________________TIN#_______________________________

Government Contract number if applicable: ____________________________

Contract Purpose (e.g., support service, R&D, etc.)?______________________

Contract Award Date: _________ Period of Performance: _________________

Total Contract Value: ___________ Contract Value Per Year: ______________

Name and phone number(s) of contact who can verify your work performance and submitted information:

Contact Name and Title: ____________________________________________

Contact Phone Number _____________________________________

Contact Email Address: _____________________________________

PROVIDE A BRIEF DESCRIPTION OF ALL SERVICES PERFORMED ON THE CONTRACT.

Number of buildings, type(s), and number of occupants on campus or facility: ___________________

Capacity of Chilled Water Plant in ton hours: ____________________________

Annual Chilled Water Production in tons divided by the number of hours of operation ___________

Capacity of Chilled Water Distribution System in gallons: ____________________________

Size of Boiler Plant in pounds per hour: ______________________________ Amount of Bulk Deliveries in Gallons: ______________ Amount of Neat Delivery in Gallons: _________