Exhibit A Corporate Experience Form.docx

RFP N4008420R0405

RFP N4008420R0405

CUI//FEDCON [when filled in] RFP N4008422R0051, Exhibit A Source Selection Information – See FAR 2.101 and 3.104 [when filled in] The offeror shall complete all sections in English.

CORPORATE EXPERIENCE FORM

Use this form to provide the Corporate Experience Narrative. Individual blocks on this form may be expanded; however, total length shall not exceed 2 single-sided (1 double sided) pages. Additional pages will not be considered.

Project No. (check one) : |_| #1 |_| #2 |_| #3 |_| #4 |_| #5

1. Experience for: |_| Offeror |_| Joint-Venture |_| Other (Explain)

Firm Name:

Address:

Phone Number:

Point of Contact: Contact Phone Number:

2. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other (Explain)

Percent of project work performed:

If subcontractor, who was prime (Name/Phone #):

3. Contract Number: Delivery/Task Order Number:

Title:

Location:

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

5. Type of work:

|_| Maintenance |_| Repair |_| Alteration |_| Other (explain):

6. Type of Contract/Task Order: (Check ALL that apply) |_| Firm-Fixed Price |_| Cost/Time and Material |_| Other (explain):

7. Award Amount: Final Price:

8. Provide a detailed description of the project and the relevancy to the project requirements of this RFP (Include applicable annex in accordance with Factor 1)

9. Provide a detailed description of what work your firm self-performed on this project:

10. Other Information:

NOTE: NAVFAC REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE

AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE

COMPLETED QUESTIONNAIRE TO NAVFAC WITH THEIR PROPOSAL, AND MAY

DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON NAVFAC

SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES

DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED

DIRECTLY TO NAVFAC. PLEASE CONTACT THE OFFEROR FOR NAVFAC POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

CUI//FEDCON [when filled in] Source Selection Information – See FAR 2.101 and 3.104 [when filled in]