Attachment_A_-_Const_Des_Experience_Proj_Form.doc

ATTACHMENT A

CONSTRUCTION & DESIGN EXPERIENCE PROJECT DATA SHEET

Project No. (check one) : FORMCHECKBOX

CON #1 FORMCHECKBOX

CON #2 FORMCHECKBOX

CON #3 FORMCHECKBOX

CON #4 FORMCHECKBOX

CON #5

FORMCHECKBOX

DESIGN #1 FORMCHECKBOX

DESIGN #2 FORMCHECKBOX

DESIGN #3 FORMCHECKBOX

DESIGN #4 FORMCHECKBOX

DESIGN #5

1. Experience for: FORMCHECKBOX Offeror FORMCHECKBOX Joint-Venture FORMCHECKBOX Other (Explain) Firm Name:

Address:

Phone Number:

DUNS Number:

Point of Contact: Contact Phone Number:

2. Work Performed as: FORMCHECKBOX Prime Contractor FORMCHECKBOX Sub Contractor FORMCHECKBOX Joint Venture FORMCHECKBOX 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:

FORMCHECKBOX

New Construction FORMCHECKBOX Renovation FORMCHECKBOX Repair FORMCHECKBOX Alteration FORMCHECKBOX Other (explain):

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

Firm-Fixed Price FORMCHECKBOX Cost/Time and Material FORMCHECKBOX

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)

FORMCHECKBOX

Design-Build FORMCHECKBOX Design-Bid-Build FORMCHECKBOX Delivery/Task Order (IDIQ) FORMCHECKBOX

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)

FORMCHECKBOX

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

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:

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Attachment A (10-02-12)