Attach_F_-_Past_Performance_Info.docx

ATTACHMENT F

PAST PERFORMANCE PROJECT INFORMATION

Request for Proposal: FA2823-18-R-4011 FTFA 17-1109 Repair Water Main and Fire Suppression at SRI Tower Bldg 9284 Eglin AFB, FL 32542

Name of Offeror: ___________________________________

Point of Contact:

Telephone #:

E-Mail:

We are currently in the process of preparing our proposal for Solicitation Number FA2823-18-R-4011, for the repair of the water main and fire suppression system at the Santa Rosa Island Tower Bldg 9284 located on at Eglin AFB, Duke Field and the Eglin Range, Florida. As part of our proposal, we have offered as a reference on our performance for this type of work, under the previous/current contract listed below, with your company. Your input on our performance is therefore requested. Please complete this survey and provide a sufficient description so this contract may be evaluated whether it is the same or similar in scope to this solicitation. Please return to the Point of Contact listed above. Thank you.

Survey is due no later than

1. Contract or Identifying Number:

2. Please provide a brief description of the work we performed for your contract that was same/similar to the below or say none:

i: Prior experience with maintenance and repair of water storage tanks and how recently:

ii: Prior experience with exterior and interior media blasting of water storage tanks and how recently:

iii: Prior experience with priming, painting and re-caulking water storage tanks and how recently:

iv: Prior experience with furnishing and installing safety climb systems, access manways (manhole), and safety grids, and how recently:

v: Prior experience with Air Force water storage tanks and how recently:

vi. Prior experience with land clearing and storm water diversion structures:

3. Period of Performance (Base) ___________________________ Amount $_______________________________ Period of Performance (1st Option) _________________________ Amount $_______________________________ Period of Performance (2nd Option) ________________________ Amount $_______________________________ Period of Performance (3rd Option) _________________________Amount $_______________________________ Period of Performance (4th Option) _________________________Amount $_______________________________

TOTAL: $______________________________

4. Offeror performed as the ____ Prime Offeror ____ Sub-Contractor____ Key Personnel

5. Type of Contract ____ Firm-Fixed-Price ____ Cost Reimbursement ____ Other (please specify)

6. Name of Person Completing Survey:

Base/Company: ________________________ Date: _________________

Title: _________________________________ Phone: ________________

Email:_________________________________ Fax:__________________