Encl 3_KTR Info Sheet N40084FY26SPILL.pdf

(Rev. 03/13)

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM for

N40084FY27SPILL RAPID SPILL RESPONSE AND PREVENTION

CONTRACT AT VARIOUS U.S. NAVY, MARINE CORPS, ARMY AND AIR

BASES AND FACILITIES THROUGHOUT JAPAN

Use this form to provide contractor’s general information. Please limit response to one page. The box at the bottom of this form may be used to clarify any requested information.

Contractor Information:

Firm Name:

Address:

CAGE CODE: UEI:

Name of POC for firm:

Phone Number of POC: Email of POC:

Questionnaire:

1. Did you submit a response to the previous Sources Sought posted February 2025?

2. Do you have all necessary registration, licenses, and/or certifications to conduct business in Japan in accordance with the draft PWS? If not, which registration, licenses, and/or certifications do you have an issue obtaining and why?

3. Would your company intend to form a Joint Venture, partnership, LLC, or subcontract portions of work to satisfy the requirements listed in this Sources Sought?

☐Yes ☐No

4. Do you prefer payment to be denominated in USD or JPY?

5. This space may be used to provide any additional information that is relevant:

(Rev. 03/13)

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM for

N40084FY26SPILL RAPID SPILL RESPONSE AND PREVENTION

CONTRACT AT VARIOUS U.S. NAVY, MARINE CORPS, ARMY AND AIR

BASES AND FACILITIES THROUGHOUT JAPAN

Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement. Submit up to 3 projects. Please limit response to two pages per project.

1. Contractor Name:

2. Project No. (check one): - 1 - 2 - 3

3. Contract Number: Delivery/Task Order No.:

Project Number:

Title:

Location:

4. Award Date (mm/dd/yy):

Completion Date (mm/dd/yy):

Project is % complete (on submission due date)

5. Final Contract Price: ¥ (incl. all options and mods)

This is the total project subcontract price.

6. Type of work: Facilities Support Maintenance/Overhaul/ Repair/ Alteration services

7. Customer/Owner Name:

Point of Contact Name/Title:

(person with project knowledge)

POC Phone Number: POC Email Address:

8. Were you the Prime contractor for this project? Yes No

Were you a subcontractor for this project? Yes No

If subcontractor, who was the Prime contractor?

9. Type of Contract (check all that apply):

Firm Fixed-Price (FFP) Indefinite Delivery / Indefinite Quantity (IDIQ)

Other (explain):

If partnership, provide the following information:

Partner firm name: Years working together:

Address:

10. Narrative Description of the Project:

11. Percentage of work you self-performed on this project: %. Explain work self-performed:

Form may be expanded. Please DO NOT change content of the form.