Attachment A - Project Information Sheet.pdf

W912HV20R0002

ATTACHMENT A

PROJECT INFORMATION SHEET

Use one form per project and use additional pages as necessary to provide the requested information. Provide the following information to demonstrate experience. Each project should not exceed 5 pages per project.

a. Name of Offeror on this solicitation: ______________________________________________________________

b. Cage Code of Offeror on this solicitation: __________________________________________________________ NOTE: If joint venture, offeror must be registered as such in System for Award Management prior to due date and time of proposals. The joint venture, shall also hold an active Top Secret Facility Clearance Level.

c. Project Title & Contract/Task Order Number: _____________________________________________________

d. Location/Site (Include Country, Prefecture and City where the project was performed):

e. Name of Company/Firm Involved in this completed project as the prime contractor (if this project was performed by a Joint Venture (JV), also indicate all JV members, cage codes, and copy of joint venture agreement).

f. General Scope of Project/Project Description. Describe how this project meets the Past Experience evaluation criteria in Section 00 22 16. Include type and extent of Design effort required the project. Do not include classified information.

g. Identify key work disciplines your company/firm employed on this project.

h. Please explain your Role in the project and your primary responsibilities (role of offeror on completed project;

such as, Prime Contractor, 1st tier Sub-Contractor or Joint Venture member). If your role was the 1st tier sub-contractor, please include the percent (%) of invoiced effort your company completed:

i. Date Construction Began:_____________________________________________________________________ Completed: ________________________________________________________________________________

j. Total Contract/Project Value:

For each of the following entries, clearly identify whether the figure is denominated in U.S. dollars ($) or Japanese yen (¥). Either use the symbols for each currency ($ or ¥) or state definitively in English ("dollars" or "yen")

Initial Contract/Project Value: ______________________________________________ ___ _ Modifications (State the number of modifications and the total sum value of all modifications): ___________ _ Reasons for each Modification:

k. If this project was performed by the offeror’s parent/subsidiary/affiliate firm, describe the nature of the affiliation and describe how the parent/subsidiary/affiliate firm’s resources (workforce, management, facilities or other resources) will significantly contribute to the execution of this project.

l. Provide two Points of Contact for Client/Agency (if client is the U.S. Government, provide name and address of contracting office, name and telephone number of Contracting Officer):

(1)

Name: _________________________________________________________________ Telephone No. __________________________________________________________ E-mail: ________________________________________________________________ Address: _______________________________________________________________

(2)

Name: _________________________________________________________________

Telephone No.___________________________________________________________ E-mail: _________________________________________________________________ Address: ________________________________________________________________