Attachment (1) Sources Sought_Contractor_Info_Form.docx

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: Repair of Five of Construction Equipment at Camp Shields, Okinawa and Iwakuni Air Station, NMCB-5, Japan
Solicitation number
N4008423Q3603
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SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

Repair of Five (5) Construction Equipment at Camp Shields, Okinawa and MCAS Iwakuni, NMCB-5, Japan

Use this form to provide contractor’s general information. Please limit response to one page. The box at the bottom of this form may be used to clarify any requested information.

1. Contractor Information:

Firm Name:

Address:

Name of POC for firm:

Phone Number of POC: Email of POC:

2. System for Awards Management (SAM):

Cage Code:

3. License/Permits: Do you currently possess a license for the following:

a) Authorized Caterpillar repair Y or N

b) Available to conduct repair work at both sites in Okinawa and Iwakuni Y or N

4. This space may be used to provide any additional information that is relevant:

(Rev. 03/13)

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

Repair of Five (5) Construction Equipment at Camp Shields, Okinawa and MCAS Iwakuni, NMCB-5, Japan Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement. Submit up to 5 projects. Please limit response to two pages per project.

1.Contractor Name:
2.Project No. (check one):- 1- 2- 3- 4- 5
3.Contract Number:Delivery/Task Order No.:

Project Number:

Title:

Location:

4. Award Date (mm/dd/yy):Completion Date (mm/dd/yy):Project is % complete (on submission due date)
5.Final Contract Price:¥

(incl. all options and mods)

This is thetotal projectsubcontract price.
6.Type of work:Facilities SupportMaintenance/Overhaul/ Repair/ Alteration services
7.Customer/Owner Name:

Point of Contact Name/Title:

(person with project knowledge)

POC Phone Number:POC Email Address:
8.Were you the Prime contractor for this project?YesNo Were you a subcontractor for this project?YesNo

If subcontractor, who was the Prime contractor?

9. Type of Contract (check all that apply):

Firm Fixed-Price (FFP) Indefinite Delivery / Indefinite Quantity (IDIQ) Other (explain):

If partnership, provide the following information:

Partner firm name: Years working together:

Address:

10. Narrative Description of the Project:

11. Percentage of work you self-performed on this project: %. Explain work self-performed:

Form may be expanded. Please DO NOT change content of the form.

File details come from the government source that posted it. Updated .