Attachment D - Corporate Experience Questionnaire.docx

DOCX document 15 KB Posted

Attached to
Water Treatment for NIH CUP Federal contract opportunity
Solicitation number
75N99022R00038
Issued by
Department of Health and Human Services National Institutes of Health Construction

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Amendment 002 _ Attachment A - C108435 Proposed Chemical Products Form 07-06-2022.xlsx XLSX spreadsheet
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Attachment A - C108435 Proposed Chemical Products Form.xlsx XLSX spreadsheet
Attachment 6 - Safety Data Sheets for NIH NPDES Permit Chemicals.pdf PDF
Attachment 4 - Current Chemical Products.xlsx XLSX spreadsheet
75N99022R00038 (RFP).pdf PDF
Attachment C - Laboratory Testing Requirements Checklist.xlsx XLSX spreadsheet
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Attachment B - Contractor Qualification Form Rev. 4.docx DOCX document
C108435 Bid Form Bldg 11 Water Treatment.xlsx XLSX spreadsheet
Attachment 1 - C108435 Specifications and Operating Capacities of Mechanical Systems.pdf PDF
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Attachment D - Corporate Experience Questionnaire Please complete this form for three (3) projects conducted in the past five (5) years that are similar in size and scope to the services described in the Statement of Work.

Customer No. :

Client/Company/Agency Name: ___________________________________

Address Line 1: _____________________________________________

Address Line 2: _____________________________________________

Contract Type: ________________TIN#_______________________________

Government Contract number if applicable: ____________________________

Contract Purpose (e.g., support service, R&D, etc.)?______________________

Contract Award Date: _________ Period of Performance: _________________

Total Contract Value: ___________ Contract Value Per Year: ______________

Name and phone number(s) of contact who can verify your work performance and submitted information:

Contact Name and Title: ____________________________________________

Contact Phone Number _____________________________________

Contact Email Address: _____________________________________

PROVIDE A BRIEF DESCRIPTION OF ALL SERVICES PERFORMED ON THE CONTRACT.

Number of buildings, type(s), and number of occupants on campus or facility: ___________________

Capacity of Chilled Water Plant in ton hours: ____________________________

Annual Chilled Water Production in tons divided by the number of hours of operation ___________

Capacity of Chilled Water Distribution System in gallons: ____________________________

Size of Boiler Plant in pounds per hour: ______________________________ Amount of Bulk Deliveries in Gallons: ______________ Amount of Neat Delivery in Gallons: _______________

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