Attachment F Experience Form.docx

FACTOR 1: EXPERIENCE

USE ONE FORM PER PROJECT

1. Indicate if work was performed as a Prime Contractor or Subcontractor:

___ Prime ___ Subcontractor

2. Name of Offeror:

3. Project Title:

4. Contract/Project Number:

5. Project Location (Street Address, City, State, Zip):

6. Construction Start Date (Month/Year):

7. Construction Completion Date (Month/Year):

8. Total Contract Value: $ (Final value if completed, current value if not completed)

9. If performed as Subcontractor, the $ value of Subcontract: $

10. Name of Customer/Client:

11. Telephone Number of Customer/Client:

12. Email Address of Customer/Client:

13. Describe General Scope of the Construction Project (include weight of object lifted):

14. Describe the in-water location the work was performed at:

15. Indicate if this project had ANY recordable safety incidents: ___ YES | ___ NO

16. Indicate if this project had ANY fall related safety incidents: ___ YES | ___ NO

17. Attach at least 1 representative photograph or image of the project: