Past_Experience_Reference_Sheet,_Atch_4.doc

ATTACHMENT 4

FA561319QA014

Technical Inspection of the Above and Underground Tanks

PAST EXPERIENCE QUESTIONNAIRE

This Acquisition is for the Technical Inspection of Above and Underground Storage Tanks within the Kaiserslautern Military Community.

Instructions: Please complete a separate form for each relevant contract (similar in size, scope or type of work) held within the last 3 years.

Past Experience for Offeror: _______________________________ Your CAGE Code: ____________________

A.

GENERAL INFORMATION: Please enter your information below:

Prime Contractor’s Name:

Subcontractor’s Name:

Telephone Number:

Email Address:

Point of Contact:

Project Title or Brief Description of Work:

Contract Number:

Contract Amount:

Contract Period or Dates of Performance:

Contractor performed as the ( Prime Contractor ( Sub-Contractor

To be completed by the respondent and returned directly to the contracting office.

B.

SPECIFIC EXPERIENCE INFORMATION:

Description of Services Performed: ________________________________________________________________

How many Technical Inspections of the Above and Underground Storage Tanks did you accomplish?

For Official Use Only