N3319123R4017 Kombewa Water System Attach 4 - Data Sheet.docx

ATTACHMENT 4

DESIGN & CONSTRUCTION EXPERIENCE PROJECT DATA SHEET

Project No. (check one) : |_| #1 |_| #2 |_| #3 |_| #4 |_| #5

1. Experience for: |_| Offeror |_| Joint-Venture |_| Other (Explain)

Firm Name:

Address:

Phone Number:

Point of Contact: Contact Phone Number:

2. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other (Explain)

Percent of project work performed:

If subcontractor, who was prime (Name/Phone #):

3. Contract Number: Delivery/Task Order Number:

Title:

Location:

4. Award Date (mm/dd/yy): Completion Date (mm/dd/yy):

5. Type of work:

|_| New Construction |_| Renovation |_| Repair |_| Alteration |_| Other (explain):

6. Type of Contract/Task Order: (Check ALL that apply)

|_| Firm-Fixed Price |_| Cost/Time and Material |_| Other (explain):

Complete Block 7 for Construction Projects. Complete Block 8 for Design Projects.

7. Construction Project:

Award Amount: Final Price:

Type of Contract/Task Order: (Check ALL that apply)

|_| Design-Build |_| Design-Bid-Build |_| Delivery/Task Order (IDIQ) |_| Other (explain):

If Design-Build, identify the Lead Design Firm:______________________________________________

8. Design Project:

A/E Design Fee: Total Construction Value:

Type of Contract/Task Order: (Check ALL that apply)

|_| Design-Build |_| RFP Development |_| Designer of Record |_| Engineering Services |_| Full Plans & Specs

|_| Other (explain):

9. Provide a detailed description of the project and the relevancy to the project requirements of this RFP (i.e.: unique features, square footage, construction methods), including any sustainable features or USGBC LEED certifications. If design-build, include a description of the design-effort.

10. Provide a detailed description of what work your firm self-performed on this project:

11. Other Information: