B08_Attachment_5_140P8424Q0069_Tech_Info_Form.pdf

TECHNICAL INFORMATION FORM

(Attachment 5)

Repaving and Adding Additional Asphalt to the Tule Lake Visitor Center Driveway Access Tule Lake National Monument

RFQ No.: 140P8424Q0069

Quoters shall submit the following information:

Quoters Business Name: ___________________________________

Quoters Address: ___________________________________

Quoters UEI: ___________________________________

Quoters Phone: ___________________________________

Quoters Contact Name: ___________________________________

Quoters Signature: ___________________________________

CONTRACTOR’S PROPOSED TEAM:

Do you plan to self-perform all of the work? ___________________________

YES or NO answer

Are you proposing to use a subcontractor? ___________________________ YES or NO answer

List any proposed subcontractor(s) and indicate what key trade they may be assigned to perform:

Subcontractor Name Key Trade (Roofing, etc.)

If you are proposing to use a subcontractor, describe what work activities you plan to self-perform:

RFQ No. 140P8424Q0069, Attachment 5, Technical Information Form

LIST OF RELEVANT EXPERIENCE (LIST OF PROJECTS) & PAST PERFORMANCE REFERENCES:

1) Project Title: ___________________________ Contract # (if known): ______________

Agency/Owner: ___________________________ $ Amount: _______________________

Performance Period: ___________________________

Briefly describe how this project is similar in nature and scope to current advertised requirement:

Past Performance Reference (Name & Title): _______________________________________________

Phone Number: ___________________________ Email: __________________________

2) Project Title: ___________________________ Contract # (if known): ______________

Performance Period: ___________________________

Briefly describe how this project is similar in nature and scope to current advertised requirement:

3) Project Title: ___________________________ Contract # (if known): ______________

Performance Period: ___________________________

Briefly describe how this project is similar in nature and scope to current advertised requirement:

RFQ No. 140P8424Q0069, Attachment 5, Technical Information Form

CALIFORNIA CONTRACTOR STATE LICENSE:

Is your firm a CA Licensed Contractor, such as “C12” ________________________ Earthwork and Paving Contractor or “A” General Engineering YES or NO answer Contractor or other classification that is applicable to their work?

☐ license details/number: ______________________ ☐ proof of license is searchable online or include with your quote

IF you are proposing to use a subcontractor for any of the work:

Is subcontractor a CA Licensed Contractor, such as “C12” ________________________ Earthwork and Paving Contractor or “A” General Engineering YES or NO answer Contractor or other classification that is applicable to their work?

☐ license details/number: ______________________ ☐ proof of license is searchable online or include with your quote