Attch_16_-_Experience_Form.docx

DOCX document 16 KB Posted

Attached to
Base Wide CCTV - Phase 3-5 Federal contract opportunity
Solicitation number
FA700019RA002
Issued by
Department of the Air Force Headquarters Air Force Academy

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Attachment 16 - Experience Form

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FA7000-19-R-A002

Attachment 12

EXPERIENCE FORM

Contractor’s Name: ___________________________________________________________________

Address: ____________________________________________________________________________

Telephone Number: ___________________________________________________________________

Email:_______________________________________________________________________________

Contractor Point of Contact: _____________________________________________________________

Project Title: ________________________________________________________________________

Owner/Customer: ____________________________________________________________________

(Check one)

· Prime Contractor

OR

· 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***

File details come from the government source that posted it.