BNL_Contractor_Information_Form.docx
DOCX document 34 KB Posted
- Attached to
- Task Order Agreement (IDIQ) for Various Electric Projects at Brookhaven National Laboratory
- Solicitation number
- JF061725
- Issued by
-
Department of Energy Office of Science
About this file
The document is a Brookhaven National Laboratory (BNL) Contractor Information Form, designed to collect comprehensive details from potential small business contractors for an upcoming electrical services Task Order Agreement. The solicitation (JF061725) is a pre-solicitation for an Indefinite Delivery/Indefinite Quantity (IDIQ) contract with the Department of Energy Office of Science, seeking qualified contractors to perform electrical installations at BNL, including general and medium voltage electrical work, telecommunications infrastructure, and security access control systems.
The form requires detailed company information such as business size, employee count, DUNS/UEI number, CAGE code, bonding capacity, and certifications. Contractors must provide past performance details with two project examples, key personnel information, and three professional references. Interested small businesses are instructed to complete the form and submit it via email to Joseph Famiglietti at jfamiglie@bnl.gov, including their Sam.gov Unique Entity Identifier. The form serves as a pre-qualification tool for potential contractors to demonstrate their capabilities for upcoming electrical service task orders at Brookhaven National Laboratory.
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Text version
Brookhaven National Laboratory (BNL) - Contractor Information Form Company Information **Company Name:** _______________________________________________________ **Business Address:** _______________________________________________________ **City, State, Zip:** _______________________________________________________ **Website:** _______________________________________________________ **Primary Contact Name:** _______________________________________________________ **Title:** _______________________________________________________ **Phone Number:** _______________________________________________________ **Email Address:** _______________________________________________________ Company Overview **Year Established:** _______________________________________________________ **Business Size (Small Business, Large Business, etc.):** _______________________________________________________ **Number of Employees:** _______________________________________________________ **DUNS Number / UEI:** _______________________________________________________ **CAGE Code:** _______________________________________________________ **Bonding Capacity ($):** _______________________________________________________ **Certifications (SBA 8(a), HUBZone, SDVOSB, WOSB, MBE, etc.):** _______________________________________________________ Core Competencies (Briefly describe your company’s key construction and engineering services) Past Performance & Historical Projects **Project 1 Name:** _____________________________________________________ **Location:** _______________________________________________________ **Scope of Work:** _______________________________________________________ **Contract Value:** _______________________________________________________ **Completion Date:** _______________________________________________________ **Client/Agency:** _______________________________________________________ **Project 2 Name:** _____________________________________________________ **Location:** _______________________________________________________ **Scope of Work:** _______________________________________________________ **Contract Value:** _______________________________________________________ **Completion Date:** _______________________________________________________ **Client/Agency:** _______________________________________________________ (Attach additional project summaries as needed) Key Personnel (Provide names and titles of key individuals, along with their resumes if available) References (Provide at least three references from past clients) **Reference 1:** **Company/Agency Name:** _______________________________________________________ **Contact Person:** _______________________________________________________ **Title:** _______________________________________________________ **Phone:** _______________________________________________________ **Email:** _______________________________________________________ **Reference 2:** **Company/Agency Name:** _______________________________________________________ **Contact Person:** _______________________________________________________ **Title:** _______________________________________________________ **Phone:** _______________________________________________________ **Email:** _______________________________________________________ **Reference 3:** **Company/Agency Name:** _______________________________________________________ **Contact Person:** _______________________________________________________ **Title:** _______________________________________________________ **Phone:** _______________________________________________________ **Email:** _______________________________________________________ Additional Information (Include any other relevant details, capabilities, or documents that support your company’s qualifications) Submission Instructions **Please return this completed form along with any supporting documents to: jfamiglie@bnl.gov
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