EXHIBIT A-Past Performance Project Data - REVISED.docx

EXHIBIT “A” – OFFEROR

PAST PERFORMANCE PROJECT DATA SHEET

RFP # HQ0034-12-R-0004

The purpose of this form is to provide supporting project information for Past Performance. This form is to be completed by the Offeror.

1. Project No. (check one): |_| - 1 |_| - 2 |_| - 3

2. Contract Number, Delivery/Task Order Number, Project Number, Title, and Location:

3. Award Date (mm/dd/yy):

Completion Date (mm/dd/yy):

4. Award Amount:

Final Contract Price (including all options):

Is this the |_| total project or |_|subcontract price

5. Type of work: |_| New Construction |_| Renovation |_| Repair |_| Alteration

6. Type of Contract:

|_| Design-Build |_| Design-Bid-Build |_| Other (explain):

7. Firm Who Performed the Work: (check one)

|_| Contractor |_| Sub Contractor

Firm’s Name:

If your firm was a subcontractor on this project, identify the prime:

If a Design-Build Project, identify the Lead Design Firm:

8. Customer/Owner Information:

Customer Name:

Point of Contact:

Phone Number:

FAX Number:

E-mail address:

9. If this project was performed by key personnel, a subsidiary, satellite office, or parent company, explain how this office/person will participate in this contract.

10. Provide a detailed description of the project:

11. Provide a detailed description of what work your firm self performed on the project:

12. Was the project completed ahead of schedule? If so, how many calendar days ahead?

13. Was the project completed without safety related incidents? If not, provide a description of the incidents and the resultant time lost. Also include what corrective actions, if any, were taken.

14. Provide the final performance rating received for this project. For design type projects, 100% completed (final construction documents completed) and the construction is at least 50% complete, provide any interim rating received. If the rating received was less than Satisfactory, then provide a brief description of the problem(s) resulting in this evaluation and what corrective action, if any, was taken.

15. Attach any legible copies or photographs of industry awards/special recognitions, etc., received for this project.

Form may be expanded