Atach_11_Experience_Form_Rev_1.pdf
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- Attached to
- Phases 1A, 1B, & 2 of CCTV System Federal contract opportunity
- Solicitation number
- FA7000-17-R-0007
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Atach 11 Experience Form Rev 1
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Text version
FA7000-17-R-0007
Attachment 11
EXPERIENCE FORM
Contractor’s Name: ___________________________________________________________________
Address: ____________________________________________________________________________
Telephone Number: ___________________________________________________________________
Email:_______________________________________________________________________________
Point of Contact: _____________________________________________________________________
Project Title: ________________________________________________________________________
Owner/Customer: ____________________________________________________________________
(Check one) o Prime Contractor
OR
o Subcontractor
Place of Performance: _________________________________________________________________
Contract Number: ____________________________________________________________________
Contract Value: ______________________________________________________________________
Contract Period or Dates of Performance: _________________________________________________
Project Description:___________________________________________________________________
Number of CCTV Cameras Installed: _____________
Circle types of construction work performed during this project: Drywall Repair New Conduit Installation
Electrical Work Indoor Mounting Outdoor Mounting CCTV Installation
Contract Point of Contact to Verify Above Project
Point of Contact: _____________________________________________________________________
Address: ____________________________________________________________________________
Telephone Number: ___________________________________________________________________
Email:_______________________________________________________________________________
***Only one Experience Form will be accepted***
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