Attachment_1-Sources_Sought_Contractor-Information-Form_N4008424R0041_.pdf

(Rev. 03/13)

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

INDEFINITE DELIVERY INDEFINITE QUANTITY (IDIQ), DESIGN BUILD (DB) / DESIGN-BID-BUILD

(DBB), MULTIPLE AWARD CONSTRUCTION CONTRACT (MACC) FOR U.S. GOVERNMENT

INSTALLATIONS IN THE OKINAWA REGION, JAPAN

Use this form to provide contractor’s general information. Please limit response to one page.

1. Contractor Information:

Firm Name:

Unique Entity ID Number:

CAGE Code:

Address:

Point of contact for firm:

Phone Number of POC: Email of POC:

2. Fill in:

NAICS Code(s)

Socio-Economic Status:

Circle one

Large Business

3. Does your company regularly engage in the business of providing design build and/or design-bid-build construction type projects listed in the sources sought? YES NO

a. If yes to Question 3, please list the specific types of tasks/services provided.

b. If yes to Question 3, how long has your company provided these types of services?

4. Please list up to five (5) contracts your company is currently performing that would be considered the same as or similar to this effort (size, scope, complexity), as well as those you have completed within the last five (5) years.

Please include:

(a) Contract Number and Title

(b) Name of Contracting Activity,

(c) Contract type (firm fixed price, cost, indefinite delivery/indefinite quantity, or Combination),

(d) Period of Performance, (start and completion date)

(e) Basic Contract Award Amount with Options,

(f) Contract Value Per Year,

(g) Current/Final Contract Amount,

(h) Summary of Contract Work, and

(i) Contracting Officer Name and Current Telephone Number.

Interested sources do not need to meet Joint-Venture requirements at this point since this sources sought notice is solely for market research purposes and not a Request for Proposal (RFP).

**Form may be expanded. Please DO NOT change content of the form.** (Rev. 03/13)

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

INDEFINITE DELIVERY INDEFINITE QUANTITY (IDIQ), DESIGN BUILD (DB) / DESIGN-BID-

BUILD (DBB), MULTIPLE AWARD CONSTRUCTION CONTRACT (MACC) FOR U.S.

GOVERNMENT INSTALLATIONS IN THE OKINAWA REGION, JAPAN

Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement (similar in size, scope, complexity). Submit up to 5 projects. Limit response to 2 pages per project.

1. Contractor Name:

2. Project No. (check one): - 1 - 2 - 3 - 4 - 5

3. Contract Number: Delivery/Task Order No.:

Title:

Location:

4. Award Date (mm/dd/yy): 5. Final Contract Price: $

Completion Date (mm/dd/yy): (includes. all options and mods)

Project is % complete (as of submission due date) This is the total project subcontract price.

6. Customer/Owner Name:

Point of Contact Name/Title:

(person with project knowledge)

POC Phone Number: POC Email Address:

7.

Were you the Prime contractor for this project?

Were you a subcontractor for this project?

If subcontractor, who was the Prime contractor?

Yes No

Yes No

8. Type of Contract (check all that apply): Design-Build Design-Bid-Build Firm-Fixed Price Cost/Time & Material

Other (explain):

If Design-Build, provide the following information: Design accomplished in-house

Lead design firm name:

Address:

Years working together:

9. Type of work: New Construction Renovation Alteration Repair Demolition Design

10. Narrative Description of the Project:

11. Percentage of work you self-performed on this project: % and (dollar value).

Explain work self-performed:

**Form may be expanded. Please DO NOT change content of the form.** (Rev. 03/13)

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