Attachment (5) Experience Project Data Sheet N4008422R7003.doc

CUI//FEDCON [when filled in]

Source Selection Information--See FAR 2.101 and 3.104 [when filled in] Maintenance Services for Wastewater Treatment Plant, N40084-22-R-7003

Bldg. 961, NAF Misawa, Japan CUI//FEDCON [when filled in]

Source Selection Information--See FAR 2.101 and 3.104 [when filled in] Maintenance Services for Wastewater Treatment Plant, N40084-22-R-7003

Bldg. 961, NAF Misawa, Japan

ATTACHMENT (5)

EXPERIENCE

The offeror shall complete all sections in English.

EXPERIENCE PROJECT DATA SHEET

Project No. (check one) : FORMCHECKBOX

#1 FORMCHECKBOX

#2 FORMCHECKBOX

#3 FORMCHECKBOX

#4 FORMCHECKBOX

#5

1. Experience for: FORMCHECKBOX Offeror FORMCHECKBOX Joint-Venture FORMCHECKBOX Other (Explain)

Firm Name:

Address:

Phone Number:

Point of Contact: Contact Phone Number:

2. Work Performed as: FORMCHECKBOX Prime Contractor FORMCHECKBOX Sub Contractor FORMCHECKBOX Joint Venture FORMCHECKBOX Other (Explain)

Percent of project work performed:

If subcontractor, who was prime (Name/Phone #):

3. Contract Number: Delivery/Task Order Number:

Title:

Location:

4. Award Date (mm/dd/yy): Completion Date (mm/dd/yy):

5. Type of work:

FORMCHECKBOX

New Construction FORMCHECKBOX Renovation FORMCHECKBOX Repair FORMCHECKBOX Alteration FORMCHECKBOX Services FORMCHECKBOX Other (explain):

6. Type of Contract/Task Order: (Check ALL that apply)

FORMCHECKBOX

Firm-Fixed Price FORMCHECKBOX Cost/Time and Material FORMCHECKBOX

7. Award Amount: Final Price:

Type of Contract/Task Order: (Check ALL that apply)

FORMCHECKBOX

Delivery/Task Order (IDIQ) FORMCHECKBOX

8. Provide a detailed description of the project and the relevancy to the project requirements of this RFP (Include applicable annex in accordance with Factor 3)

9. Provide a detailed description of what work your firm self-performed on this project:

10. Other Information:

Rev Dec 2021 CUI//FEDCON [when filled in]

Source Selection Information--See FAR 2.101 and 3.104 [when filled in] Rev Dec 2021 CUI//FEDCON [when filled in]

Source Selection Information--See FAR 2.101 and 3.104 [when filled in]