B08_140P2021R0027_Attach 4 PSP.pdf

SHENANDOAH NATIONAL

PARK

Solicitation # 140P2021R0027

Pavement Improvements for SHEN

SHEN 222242

REQUEST FOR PROPOSAL

(RFP)

Proposal Submission Package

NATIONAL PARK SERVICE

DENVER SERVICE CENTER

For Technical Volume I:

1. Experience Questionnaire

2. Subcontractor Reference

3. Key Personnel Qualifications

4. Past Performance Questionnaire

5. Hazardous Materials Identification Listing

For Business & Price Volume II:

1. SF 1442

2. Contract Price Schedule

3. SF 24 Bid Bond

4. Section K – Representations and Certifications

5. General References

Project Experience Questionnaire Solicitation: 140P2021R0027

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 Company Name

CONTRACTOR LIST

List Prime and / or key trades contractors that worked on the referenced project who will also work on the proposed project

Prime or Subcontractor Role / Key Trade Company Name

Prime Contract / Construction Management

ABC Construction

Subcontractor Masonry Brickworks Inc

REFERENCED PROJECT INFORMATION

Project Title Title Project Value $XX,XXX,XXX

Project Location City, State Project End Date MM/DD/YYYY

Original Contract Price $XXX,XXX Final Contract Price $XXX,XXX

Original Completion Date MM/DD/YYYY Final Completion Date MM/DD/YYYY

Project Owner Company Name POC: First Last Name Phone: XXX‐XXX‐XXXX

PROJECT EXPERIENCE QUESTIONS

1. Which Project Experience elements in section L of the solicitation does the project address?

Response

2. Provide a description of the referenced project and the work that addresses the elements referenced in question 1 above.

Response

3. Describe & provide reasons for any contract price impacts.

Response

4. Describe and provide reasons for any contract time impacts.

Response

5. Describe problems encountered and how you resolved them. Describe how the offeror’s proposal accounts for similar issues.

Response

6. Describe the means and methods employed on the referenced project that were successful. Would you implement the same means and methods on the proposed project? Why or why not?

Response

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

Response

NPS Solicitation Package 140P2021R0027 SHEN‐222245

NPS Solicitation Package 140P2021R0027 SHEN-222242

Subcontractor Reference READ CAREFULLY: The purpose of this form is for the offeror to list certain subcontractors identified in the Instructions, Conditions, and Notices to Offerors (Section L) who are considered critical to the successful accomplishment of the project. Use as many sheets as necessary. These subcontractor references should include additional relevant projects similar to the work described in the plans and specifications. Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

SUB CONTRACTOR (PROPOSED):

ADDRESS:

TELEPHONE NUMBER: ( )

# PROJECT NAME:

Name of Owner:

Location:

Prime Contractor

Telephone Number:

Subcontract $ Value:

Dates of Construction:

Reference Name and Telephone Number: ( ) .

Dates of Construction:

DESCRIPTION & SCOPE OF WORK

SPECIFIC AREAS OF EXPERIENCE (SEE INSTRUCTIONS FOR THE SUBMISSION OF OFFERS AND OTHER

INFORMATION – CAPABILITY CRITERIA):

NPS Solicitation Package 140P2021R0027 SHEN‐222242

Key Personnel Qualifications READ CAREFULLY: The purpose of this form is for the Offeror to list the qualifications of all key personnel as described in the Instructions, Conditions, and Notices to Offerors (Section L). Use additional sheets as needed.

Experience and qualifications include those job-related training courses; certificates and licenses; honors;

performance awards; and specialty skills that are relevant to the proposed project. Provide dates, but do not send documents.

Provide the state in which registration or license is held and the registration or license number. Fill in the information by typing or printing legibly.

NAME OF CONTRACTOR/OFFEROR:

PERSONNEL INFORMATION:

Name:

Job Title:

Years of Experience With This Firm: Years of Experience With Other Firms:

EDUCATION AND PROFESSIONAL REGISTRATION:

Top Educational Level Obtained: Year:

Area of Specialization:

Professional Registrations:

Area of Specialization:

EXPERIENCE AND QUALIFICATIONS

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 Company Street Address Address City City State State Zip Code XXXXX DUNS Number XXXXXXX Point of Contact Name, Email, Phone

B. CONTRACT INFORMATION

Project Title Title Contract Number XXXXXXXXXX Contract Type Firm Fixed Price / Time & Materials / Cost Reimbursable / Other Awarded Contract Price $X,XXX,XXX Current / Final Price $X,XXX,XXX Contract Award Date XX/XX/XXXX Contract Completion Date XX/XX/XXXX Period of Performance XX/XX/XXX – XX/XX/XXX Project Location Park or Street address, City, State Client / Owner Company Brief description of the contract & work effort:

Scope of work description

C. REFERENCE:

Name First, Last Position / Title Title Organization Agency or Company Phone Number XXX-XXX-XXXX Email Address Email Signature Signature Date XX/XX/XXXX

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 subcontractors)? 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 submittals 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 differing & unforeseen site conditions 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 subcontractors and suppliers? 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 and superintendent? Choose an item.

Coordination with and control of subcontractors? Choose an item.

Avoidance of accidents & safety violations? 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 excellent, 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 Time / Date Name CO or CS name Title Contracting Officer / Contract Specialist Organization National Park Service – Denver Service Center Email First_Last@nps.gov

HAZARDOUS MATERIALS IDENTIFICATION

LISTING

In accordance with Clause 52.223-3, Hazardous Material Identification and Material Safety Data, of the Contract, contractor is required to identify any hazardous materials that will be delivered under this contract.

List below all known hazardous materials to be used in performance of the work and submit with the proposal/bid. If material components are unknown at the time of submission, respond with a statement to that effect.

SOLICITATION, OFFER,

AND AWARD

(Construction, Alteration, or Repair)

1. SOLICITATION NO.

140P2021R0027

2. TYPE OF SOLICITATION

SEALED BID (IFB)

x NEGOTIATED (RFP)

3. DATE ISSUED

12/14/2020

PAGE OF PAGES

1 163

IMPORTANT -- The "offer" section on the reverse must be fully completed by offeror.

4. CONTRACT NO. 5. REQUISITION/PURCHASE REQUEST NO. 6. PROJECT NO.

7. ISSUED BY CODE PDS 8. ADDRESS OFFER TO

Refer to Section "L" NPS, DSC Contracting Services Div 12795 W. Alameda Pkwy P.O. Box 25287 Denver CO 80225-0287

9. FOR a. NAME INFORMATION Jim Irwin-vallie CALL:

b. TELEPHONE NO. (Include area code) (NO COLLECT CALLS)

303-969-2937

SOLICITATION

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder."

10. THE GOVERNMENT REQUIRES PERFORMANCE OF THE WORK DESCRIBED IN THESE DOCUMENTS (Title, identifying no., date)

SHEN 222242 - Pavement Improvements for SHEN

a) This acquisition is being conducted as a competitive, total Small Business Set-aside. The North American Industrial Classification System (NAICS) code and the associated small business size standard are noted in Clause 52.204-8 in section "K" of this solicitation.

b) Estimated Price Range: Over $10,000,000.

c) Refer to section "L" for information regarding a pre-proposal site visit.

d) Information and requirements stated in section "B" through "J" & attachments noted in section "J" apply to this solicitation and the subsequent contract.

e) Refer to section "L" for proposal submittal requirements.

f) This is currently an unfunded requirement with a high expectation that funds will be available. When and if funds become available a contract will be awarded at that time.

13. ADDITIONAL SOLICITATION REQUIREMENTS:

a. Sealed offers in original and 1 copies to perform the work required are due at the place specified in Item 8 by 1700 (hour) local time 1/15/2021 (date). If this is a sealed bid solicitation, offers will be publicly opened at that time. Sealed envelopes containing offers shall be marked to show the offeror's name and address, the solicitation number, and the date and time offers are due .

b. An offer guarantee is, is not required.

c. All offers are subject to the (1) work requirements, and (2) other provisions and clauses incorporated in the solicitation in full text or by reference.

d. Offers providing less than 60 calendar days for Government acceptance after the date offers are due will not be considered and will be rejected .

NSN 7540-01-155-3212 STANDARD FORM 1442 (Rev. 4-85) Prescribed by GSA FAR(48 CFR) 53.236-1(d)

11. The Contractor shall begin performance 10 award, x notice to proceed. The performance period is calendar days and complete it within 487 calendar days after receiving x mandatory negotiable. (See52,211-10 .)

12a. THE CONTRACTOR MUST FURNISH ANY REQUIRED PERFORMANCE AND PAYMENT BONDS?

(If "YES", indicate within how many calendar days after award in Item 12b.)

YES NO 12b. CALENDAR DAYS x x

AMOUNTS

OFFER (Must be fully completed by offeror)

17. The offeror agrees to perform the work required at the prices specified below in strict accordance with the terms of this solicitation, if this offer is accepted by the Government in writing within calendar days after the date offers are due. (Insert any number equal to or greater than the minimum requirement stated in item 13d. Failure to insert any number means the offeror accepts the minimum in item 13d.)

18. The offeror agrees to furnish any required performance and payment bonds.

19. ACKNOWLEDGEMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the solicitation -- give number and date of each)

AMENDMENT NO.

DATE.

20a. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER (Type or print) 20b. SIGNATURE 20c. OFFER DATE

21. ITEMS ACCEPTED:

AWARD (To be completed by Government)

Continued...

22. AMOUNT 23. ACCOUNTING AND APPROPRIATION DATA

24. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

25. OTHER THAN FULL AND OPEN COMPETITION PURSUANT TO

10 U.S.C. 2304(c) ( ) 41 U.S.C. 253(c) ( )

26. ADMINISTERED BY CODE PDS 27. PAYMENT WILL BE MADE BY

Invoice Processing Platform System

US Department of Treasury http://www.ipp.gov

NPS, DSC Contracting Services Div 12795 W. Alameda Pkwy P.O. Box 25287 Denver CO 80225-0287

CONTRACTING OFFICER WILL COMPLETE ITEM 28 OR 29 AS APPLICABLE

28. NEGOTIATED AGREEMENT

(Contractor is required to sign this document and return 1 copies to issuing office.)

Contractor agrees to furnish and deliver all items or perform all work requirements identified on this form and any continuation sheets for the consideration stated in this contract. The rights and obligations of the parties to this contract shall be governed by (a) this contract award, (b) the solicitation, and (c) the clauses, representations,

29. AWARD

(Contractor is not required to sign this document.)

Your offer on this solicitation is hereby accepted as to the items listed. This award consummates the contract, which consists of (a) the Government solicitation and your offer, and (b) this contract award.

No further contractual document is necessary.

30a. NAME AND TITLE OF CONTRACTOR OR PERSON AUTHORIZED TO SIGN (Type or print) 31a. NAME OF CONTRACTING OFFICER (Type or print)

Jeremiah Rogers 30b. SIGNATURE 30c. DATE 31b. UNITED STATES OF AMERICA

BY

31c. DATE

STANDARD FORM 1442 (REV. 4-85) BACK

14. NAME AND ADDRESS OF OFFEROR (Include ZIP Code) 15. TELEPHONE NO. (Include area code)

16. REMITTANCE ADDRESS (Include only if different than item 14.)

CODE FACILITY CODE

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED

140P2021R0027

PAGE OF

3 163

NAME OF OFFEROR OR CONTRACTOR

ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY

(C)

UNIT

(D)

UNIT PRICE

(E)

AMOUNT

(F)

PM: Jason Hand PS: Troy Siefert CO: Jeremiah Rogers CS: Jim Irwin-Vallie

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

CONTRACT

LINE ITEM

NUMBER

(CLIN)

CONTRACT LINE ITEM (CLI) TITLE QUANTITY

UNIT OF

MEASURE

UNIT PRICE TOTAL PRICE

1 Skyline Drive (Rt 00010B), Mile Posts 50 ‐ 65‐3 1 LS $ ‐ $ ‐

2 Big Meadows Entrance Road (Rt. 0034) 1 LS $ ‐ $ ‐

3 Loft Mountain Campground Access (Rt. 0076) 1 LS $ ‐ $ ‐

4 Skyland Lodge Upper Parking (Rt. 0919) 1 LS $ ‐ $ ‐

5 Doyles River Parking (Rt. 0941) 1 LS $ ‐ $ ‐

6 Hemlock Springs Overlook Parking (Rt. 1027) 1 LS $ ‐ $ ‐

7 The Oaks Overlook Parking (Rt. 1040) 1 LS $ ‐ $ ‐

8 Doyles River Overlook Parking (Rt. 1057) 1 LS $ ‐ $ ‐

9 Dundo Overlook Parking (Rt. 1058) 1 LS $ ‐ $ ‐

PROJECT TITLE: NPS SHEN ‐ Pavement Improvements AT Shenandoah National Park

CONTRACT PRICE SCHEDULE

SOLICITATION NUMBER: 140P2021R0027

PARK ‐ PMIS: SHEN 222240, 222242

DEVELOPED AREA: Shenandoah National Park, VA

TOTAL BID OPTION PRICEs (Contract Line Item Number 1‐9) ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

TOTAL PROPOSED PRICE ‐ BASE PLUS ALL OPTIONS (Contract Line Item Numbers 1 through 9) ‐‐‐‐‐‐‐‐‐‐‐

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

Notice: 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. Options may be exercised in any combination, order, or grouping.

TOTAL BASE PRICE (Contract Line Item Numbers 1 ‐ 2) ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

PARK ‐ PMIS

CPS ‐ 1

BID BOND

(See instructions on reverse)

OMB Control Number: 9000-0045 Expiration Date: 7/31/2019

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)

SU

R

ET

Y

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 25 minutes 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

#140P2021R0027

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."

SU

R

ET

Y

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

SU

R

ET

Y

C

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

SU

R

ET

Y

D

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

SU

R

ET

Y

E

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

SU

R

ET

Y

F

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

SU

R

ET

Y

G

STANDARD FORM 24 (REV. 8/2016) BACK

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:

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:

Types of Material: