Attachment_5_Proposal_Submission_Package.pdf

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Project Experience Questionnaire

Solicitation: 140P2021R0067

Submit responses to the questions below that address experience relative to the elements noted under the Project Experience evaluation subfactor in solicitation section L. Limit submittals to the quantity of projects and timeframes required in the solicitation. Expand the response sections shown below as needed to adequately address each question (this questionnaire may be expanded to multiple pages if needed).

Offeror

REFERENCED PROJECT INFORMATION

Project Title

Project Location

Brief Project Description

Project Owner

POC:

Phone:

CONTRACTOR LIST

List Contractor(s) whose experience on the referenced project is being submitted for evaluation on this proposed project. If more than one contractor is listed (i.e. prime and subcontractors), provide information specific to that contractor.

Contractor Name

Role on Referenced Project

(Prime or Sub)

Trade

Price

(list for each contractor’s specific work)

Performance Period

(calendar days)

(list for each contractor’s specific work)

Original

Final

Original

Final

PROJECT EXPERIENCE QUESTIONS

1. Describe the project work performed by all contractors listed above.

2. Identify which Project Experience elements listed in section L of the solicitation each contractor’s work addresses.

3. Describe & provide reasons for any changes to the original price for the work described in question 2 above.

4. Describe and provide reasons for any changes to the original schedule for the work described in question 2 above.

5. Describe problems, associated with the work described in question 2 above, which were encountered and how they were resolved. Describe how the offeror’s proposal accounts for similar issues.

6. Describe the means and methods, associated with the work described in question 2 above, which were successful. Would you implement the same means and methods on the proposed project? Why or why not?

7. Provide any other additional project information you believe should be presented.

CONTRACT

LINE ITEM

NUMBER

(CLIN)

CONTRACT LINE ITEM (CLI) TITLE QUANTITY

UNIT OF

MEASURE

UNIT PRICE TOTAL PRICE

001 Restore Easton Building Facades 1 Lump Sum $0.00

Replace Devonshire Street Sidewalk and Structure

1 Lump Sum $0.00

003 Replace Heating System 1 Lump Sum $0.00

004 Replace Emergency Generator 1 Lump Sum $0.00

Replace Lighting Fixtures on Floors 4, 5, 6, 7, 9, 10 and 11

1 Lump Sum $0.00

$0.00

PROJECT TITLE: Rehabilitate Easton Building (Exterior Restoration, Heat Distribution / Heat Generation)

CONTRACT PRICE SCHEDULE

SOLICITATION NUMBER:

PARK - PMIS: BOST 249576 - 220968

DEVELOPED AREA: Easton Building (15 State Street)

TOTAL PRICE FOR ALL OPTIONS (Contract Line Item Numbers 3 through XX) ------------------------------------

TOTAL PROPOSED PRICE - BASE PLUS ALL OPTIONS (Contract Line Item Numbers 1 through XX) -----------

All measurement and payment information is included in the project specifications, Section 012700.

Notice: Refer to FAR Clause 52.217-5, Evaluation of Options, as prescribed in FAR 17. Offerors are required to submit, a minimum, an offer that conforms to the solicitation documents with pricing for Base line items and all option line items. Failure to do so may render the proposal unacceptable. On lump-sum line items, provide the total price only. For all unit-priced line items, provide the unit price and the extended total price. If no specific line item exists for a portion of the work, include the costs in a related item. In case of error in calculation of extended prices, the unit price governs. In case of error in summation, the total of the corrected amounts govern. Round totals and extended prices to whole dollars. The Government reserves the right to award any or no options at or after the time of award.

At the option of the Government, the period for exercise of options at the proposed prices shall extend 180 calendar days from the date of award. Pricing will be evaluated based on what is determined to be the best value to the Government. Options may be exercised in any combination, order, or grouping deemed in the judgment of the Contracting Officer to offer the best value to the Government.

TOTAL BASE PRICE (Contract Line Item Number 1 through X) ------------------------------------

In addition to the offer that conforms to the solicitation documents, offerors are encouraged to submit alternate proposals that will result in cost savings to the Government. Such proposals shall clearly identity why the acceptance of the alternate proposal would be advantageous to the Government, see FAR Clause 52.215-1, Instructions to Offerors - Competitive Acquisition-Alternate II and DSC-36 Clause (Instructions for Submission of Offers and Other Information) in Section L of the Solicitation.

PARK - PMIS

CPS - 1

Price Schedule Template

General References

READ CAREFULLY: The purpose of this form is for the offeror to provide the Government with general references in the spaces provided as described in the Instructions, Conditions, and Notices to Offerors (Section L). Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their relationships with the references may be considered less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record. Provide explanations on separate sheets as necessary.

Name of Contractor/Offeror:

Surety

Name of Surety:

Address of Surety:

Name of Agent:

Telephone Number:

Corporate Bank

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

Corporate Bank

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

Insurance Company

Name:

Address:

Name of Agent:

Telephone Number:

Types of Policies:

Subcontractor

Name:

Address:

Name of Contact:

Telephone Number:

Area of Specialized Work:

Subcontractor

Name:

Address:

Name of Contact:

Telephone Number:

Area of Specialized Work:

Subcontractor

Name:

Address:

Name of Contact:

Telephone Number:

Area of Specialized Work:

Material Supplier

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material:

Material Supplier

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material:

MATERIAL Supplier

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material:

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: Offeror to complete Sections A and B and transmit questionnaire to reference.

Reference to complete Sections C and D and transmit back to Contracting Officer listed in section E.

A. CONTRACTOR INFORMATION

Company Name

Street Address

City

State

Zip Code

DUNS Number

Point of Contact

B. CONTRACT INFORMATION

Project Title

Contract Number

Contract Type

Awarded Contract Price

Current / Final Price

Contract Award Date

Contract Completion Date

Period of Performance

Project Location

Client / Owner

Brief description of the contract & work effort:

C. REFERENCE:

Name

Position / Title

Organization

Phone Number

Email Address

Signature

Date

D. EVALUATION

Rating

Definition

Exceptional

Performance met contractual requirements and exceeded many to the owner’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good

Performance met contractual requirements and exceeded some to the owner’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory

Performance met contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal

Performance did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

Unsatisfactory

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Evaluation Area

Rating

Quality

Quality of workmanship (including subconsultants)?

Choose an item.

Quality of and adherence to quality control plan?

Choose an item.

Quality of informational and technical submittals?

Choose an item.

Overall Quality Rating

Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Schedule (& Time Management)

Met project schedule milestones?

Choose an item.

Responded to owner requests in a timely manner?

Choose an item.

Informational and technical deliverables submitted timely?

Choose an item.

Promptly addressed scheduling issues?

Choose an item.

Overall Schedule (& Time Management) Rating

Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Cost Control

Addressed design errors and omissions so as to minimize additional costs?

Choose an item.

Provided fair and reasonable pricing for contract modifications?

Choose an item.

Submitted accurate and complete invoices?

Choose an item.

Promptly paid subconsultants?

Choose an item.

Overall Cost Control Rating

Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Management

General oversight by project manager?

Choose an item.

Coordination with and control of subconsultants?

Choose an item.

Addressed location factors (especially remote locations)?

Choose an item.

Maintained good working relationship with owner representatives?

Choose an item.

Demonstrated flexibility, innovativeness and cooperation in resolving potential problems?

Choose an item.

Overall Management Rating

Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Small Business Subcontracting (& Labor Standards)

Met regulatory and contractual labor standards?

Choose an item.

Successfully contracted with small and socio-economically disadvantaged businesses?

Choose an item.

Quality and adherence to applicable subcontracting plans?

Choose an item.

Overall Small Business Subcontracting (& Labor Standards) Rating

Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of exceptional, marginal, & unsatisfactory are especially helpful.):

Regulatory Compliance

Met building and life safety codes?

Choose an item.

Overall Regulatory Compliance Rating

Choose an item.

Overall Recommendation:

Given what I know today about the contractor's ability to perform in accordance with the contract’s most significant requirements, I would recommend them for similar contracts:

Choose an item.

Overall Comments:

E. RETURN:

Return by

Name

Michael Moffett

Title

Contract Specialist

Organization

National Park Service – Denver Service Center

Email

CS_DSC_Proposal_Submission@nps.gov

BID BOND

(See instructions on reverse)

OMB Control Number: 9000-0045 Expiration Date: 8/31/2022

PRINCIPAL (Legal name and business address) TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

SURETY(IES) (Name and business address)

PERCENT

OF BID

PRICE

PENAL SUM OF BOND

AMOUNT NOT TO EXCEED

MILLION(S) THOUSAND(S) HUNDRED(S) CENTS

BID IDENTIFICATION

BID DATE INVITATION NUMBER

PRINCIPAL

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1. 2.

2.

3.

3.

(Seal) (Seal) (Seal) Corporate Seal

INDIVIDUAL SURETY(IES)

NAME(S)

(Seal) (Seal)

CORPORATE SURETY(IES)

SU

R

ET

Y

A

NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT ($)

2. Corporate

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

STANDARD FORM 24 (REV. 8/2016)

Prescribed by GSA - FAR (48 CFR) 53.228(a)

FOR (Construction, Supplies or Services)

OBLIGATION:

We, the Principal and Surety(ies) are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit of liability is indicated, the limit of liability is the full amount of the penal sum.

CONDITIONS:

The Principal has submitted the bid identified above.

THEREFORE:

The above obligation is void if the Principal - (a) upon acceptance by the Government of the bid identified above, within the period specified therein for acceptance (sixty (60) days if no period is specified), executes the further contractual documents and gives the bond(s) required by the terms of the bid as accepted within the time specified (ten (10) days if no period is specified) after receipt of the forms by the principal; or (b) in the event of failure to execute such further contractual documents and give such bonds, pays the Government for any cost of procuring the work which exceeds the amount of the bid.

Each Surety executing this instrument agrees that its obligation is not impaired by any extension(s) of the time for acceptance of the bid that the Principal may grant to the Government.

Notice to the surety(ies) of extension(s) is waived. However, waiver of the notice applies only to extensions aggregating not more than sixty (60) calendar days in addition to the period originally allowed for acceptance of the bid.

WITNESS:

The Principal and Surety(ies) executed this bid bond and affixed their seals on the above date.

DATE BOND EXECUTED (Must not be later than bid opening date)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 1 hour to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

JOINT VENTURE

OTHER (Specify)

PARTNERSHIPINDIVIDUAL

CORPORATION

INSTRUCTIONS

1. This form is authorized for use when a bid guaranty is required. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. The bond may express penal sum as a percentage of the bid price. In these cases, the bond may state a maximum dollar limitation (e.g., 20% of the bid price but the amount not to exceed dollars).

4. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of the bond, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bond, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety, shall accompany the bond.

The Government may require the surety to furnish additional substantiating information concerning its financial capability.

5. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the word "Corporate Seal"; and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

6. Type the name and title of each person signing this bond in the space provided.

7. In its application to negotiated contracts, the terms "bid" and "bidder" shall include "proposal" and "offeror."

B

STATE OF INCORPORATION LIABILITY LIMIT ($)

2. Corporate

Corporate

LIABILITY LIMIT ($)STATE OF INCORPORATION

1.NAME(S) &

C

LIABILITY LIMIT ($)

D

E

F

G

STANDARD FORM 24 (REV. 8/2016) BACK

BID BOND

(See instructions on reverse)

OMB Control Number: 9000-0045 Expiration Date: 8/31/2022

PRINCIPAL (Legal name and business address)

TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

SURETY(IES) (Name and business address)

PERCENT OF BID PRICE

PENAL SUM OF BOND

AMOUNT NOT TO EXCEED

MILLION(S)

THOUSAND(S)

HUNDRED(S)

CENTS

BID IDENTIFICATION

BID DATE

INVITATION NUMBER

PRINCIPAL

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1.

2.

2.

3.

3.

(Seal)

(Seal)

(Seal)

Corporate Seal

INDIVIDUAL SURETY(IES)

SIGNATURE(S)

NAME(S)

(Typed)

1.

1.

2.

2.

(Seal)

(Seal)

CORPORATE SURETY(IES)

SURETY A

NAME & ADDRESS

STATE OF INCORPORATION

LIABILITY LIMIT ($)

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1.

2.

2.

Corporate Seal

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

STANDARD FORM 24 (REV. 8/2016)

Prescribed by GSA - FAR (48 CFR) 53.228(a)

FOR (Construction, Supplies or

Services)

OBLIGATION: We, the Principal and Surety(ies) are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit of liability is indicated, the limit of liability is the full amount of the penal sum. CONDITIONS: The Principal has submitted the bid identified above. THEREFORE: The above obligation is void if the Principal - (a) upon acceptance by the Government of the bid identified above, within the period specified therein for acceptance (sixty (60) days if no period is specified), executes the further contractual documents and gives the bond(s) required by the terms of the bid as accepted within the time specified (ten (10) days if no period is specified) after receipt of the forms by the principal; or (b) in the event of failure to execute such further contractual documents and give such bonds, pays the Government for any cost of procuring the work which exceeds the amount of the bid. Each Surety executing this instrument agrees that its obligation is not impaired by any extension(s) of the time for acceptance of the bid that the Principal may grant to the Government. Notice to the surety(ies) of extension(s) is waived. However, waiver of the notice applies only to extensions aggregating not more than sixty (60) calendar days in addition to the period originally allowed for acceptance of the bid. WITNESS: The Principal and Surety(ies) executed this bid bond and affixed their seals on the above date.

DATE BOND EXECUTED (Must not be later than bid opening date)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 1 hour to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

INSTRUCTIONS

1. This form is authorized for use when a bid guaranty is required. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. The bond may express penal sum as a percentage of the bid price. In these cases, the bond may state a maximum dollar limitation (e.g., 20% of the bid price but the amount not to exceed dollars).

4. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of the bond, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bond, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety, shall accompany the bond. The Government may require the surety to furnish additional substantiating information concerning its financial capability.

5. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the word "Corporate Seal"; and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

6. Type the name and title of each person signing this bond in the space provided.

7. In its application to negotiated contracts, the terms "bid" and "bidder" shall include "proposal" and "offeror."

SURETY B

NAME & ADDRESS

STATE OF INCORPORATION

LIABILITY LIMIT ($)

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1.

2.

2.

Corporate Seal

Corporate Seal

LIABILITY LIMIT ($)

STATE OF INCORPORATION

2.

2.

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME & ADDRESS

SURETY C

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME & ADDRESS

SURETY D

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME & ADDRESS

SURETY E

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME & ADDRESS

SURETY F

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME & ADDRESS

SURETY G

STANDARD FORM 24 (REV. 8/2016) BACK

8.2.0.3062.1.452232.445150

Standard Form 24 - Bid Bond

DATE BOND EXECUTED. Enter 2 digit month, 2 digit day and 4 digit year.:

PRINCIPAL (Legal Name and business Address):

STATE OF INCORPORATION :

SURETY(IES) (Name and business address):

PERCENT OF BID PRICE:

PENAL SUM OF BOND. AMOUNT NOT TO EXCEED. THOUSAND(S):

PENAL SUM OF BOND. AMOUNT NOT TO EXCEED. HUNDRED(S):

DATE Enter 2 digit month, 2 digit day and 4 digit year.:

BID IDENTIFICATION INVITATION NUMBER:

FOR (CONSTRUCTION SUPPLIES, OR SERVICES):

1. Name(s) and title(s) (types):

2. Name(s) and title(s) (types):

3. Name(s) and title(s) (types):

INDIVIDUAL SURETY(IES) 1. NAME(S) (TYPED) :

INDIVIDUAL SURETY(IES) 2. NAME(S) (TYPED) :

CORPORATE SURETY(IES), SURETY A NAME AND ADDRESS:

STATE OF INC.:

CORPORATE SURETY(IES), SURETY A 1.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY A 2.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES) LIABILITY LIMIT(S):

If Other was selected, specify here. :

PENAL SUM OF BOND. AMOUNT NOT TO EXCEED. CENTS:

CORPORATE SURETY(IES), SURETY B 2.SIGNATURES:

CORPORATE SURETY(IES), SURETY B NAME AND ADDRESS:

CORPORATE SURETY(IES), SURETY B STATE OF INC.:

CORPORATE SURETY(IES), SURETY B 1.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY E 2.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY C 2.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY C STATE OF INC.:

CORPORATE SURETY(IES), SURETY C 1.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY C NAME AND ADDRESS:

CORPORATE SURETY(IES), SURETY D 2.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY D STATE OF INC.:

CORPORATE SURETY(IES), SURETY D 1.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY D NAME AND ADDRESS:

CORPORATE SURETY(IES), SURETY E STATE OF INC.:

CORPORATE SURETY(IES), SURETY E 1.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY E NAME AND ADDRESS:

CORPORATE SURETY(IES), SURETY F 2.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY F STATE OF INC.:

CORPORATE SURETY(IES), SURETY F 1.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY F NAME AND ADDRESS:

CORPORATE SURETY(IES), SURETY G 2.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY G STATE OF INC.:

CORPORATE SURETY(IES), SURETY G 1.NAME(S) AND TITLE(S):

CORPORATE SURETY(IES), SURETY G NAME AND ADDRESS:

CORPORATE SURETY(IES) B LIABILITY LIMIT(S):

CORPORATE SURETY(IES) C LIABILITY LIMIT(S):

CORPORATE SURETY(IES) D LIABILITY LIMIT(S):

CORPORATE SURETY(IES) E LIABILITY LIMIT(S):

CORPORATE SURETY(IES) F LIABILITY LIMIT(S):

CORPORATE SURETY(IES) G LIABILITY LIMIT(S):

3. The bond may express penal sun as a percentage of the bid price. In these cases, the bond may state a maximum dollar limitation (e.g., 20% of the bid price but the amount not to exceed dollars).:

Template for Contracts and Indi

Report on Limitations on Subcontracting [Template Version 7/25/19]

This report is required for small business, 8(a) or other socio-economic set-aside service contracts (including construction) priced at or above $150,000.

Contract Number:

Prime Contractor:

Current Total Contract Price:

Type of Set Aside:

Period of Performance

Type of Service (Required Participation): [Put an X in the applicable box below per clause 52.219-3, 14, 27,29,30]

1) Services (except construction). 50% maximum may be subcontracted to non-similary situated Subcontractors

2) General construction. 85% maximum may be subcontracted to non-similary situated Subcontractors

3) Construction by special trade contractors. 75% maximum may be subcontracted to non-similary situated Subcontractors

Participartion Calculation as of the Current Invoice

Amounts shown below shall include amounts from all previous invoices and the current invoice. Exclude the cost of materials.

1) Amount Invoiced by the Prime Contractor: $0

2) Portion of Amount Invoiced for All Similarly Situated Subcontractors (SSS)* $0

Total Amount Paid To: [Insert SSS company name] $0

Total Amount Paid To: [Insert SSS company name] $0

Total Amount Paid To: [Insert SSS company name] $0

Total Amount Paid To: [Insert SSS company name] $0

Total Amount Paid To: [Insert SSS company name] $0 Add additional rows if more than 5 SSS

3) Portion of Amount Invoiced for Non-Similarly Situated Subcontractors (NSS) $0

Total Amount Paid To: [Insert NSS company name] $0

Total Amount Paid To: [Insert NSS company name] $0

Total Amount Paid To: [Insert NSS company name] $0

Total Amount Paid To: [Insert SSS company name] $0

Total Amount Paid To: [Insert SSS company name] $0 Add additional rows if more than 5 NSS

4) Prime & SSS Participation % ERROR:#DIV/0! Modify formula if additional rows added above

5) % subcontracted to NSS ERROR:#DIV/0! Modify formula if additional rows added above

* Similarly Situated Subcontractor (SSS): is a small business subcontractor that is a participant of the same Small Business Administration (SBA) program that qualified the prime contractor as an eligible offeror and awardee of the contract as defined in 13 CFR 125.6 (i.e. Small Business, HUBZone Business, Service Disabled Veteran Owned Small Business (SDOVB), etc.)

** Limitation on Subcontracting Percentage = (Total amount invoiced by the Prime Contractor - Portion of total amount invoiced for Non-Similarly Situated Subcontractors (NSS)/ Total amount invoiced by the Prime Contractor)

Corrective Action Plan

If the NSS % noted in line 5 above is not in compliance with the % required by contract clause 52.219-3, 14, 27,29,30 then the prime contractor shall provide a written corrective action plan below:

Sheet2

Services (except construction)

General construction

Construction by special trade contractors