Sources_Sought_Contractor_Info_Form.pdf

(Rev. 03/13)

SOURCES SOUGHT

CONTRACTOR INFORMATION FORM (Part I)

Use this form to provide contractor’s general information. Please limit response to one page. The box at the bottom of this form may be used to clarify any requested information.

1. Contractor Information:

Firm

Name:

Address:

Name of Firm's POC:

POC Phone Number: POC Email Address :

2. System for Award Management (SAM ) Information:

UNIQUE ENTITY ID: ______________________________

CAGE: ______________________________

3. Qualifications for Conducting Business in Japan:

4. Interested in Performing Services as a PRIME: Yes No

Interested in Performing Services as a SUBCONTRACTOR: Yes No

5. This space may be used to provide any additional information that is relevant:

(Rev. 03/13)

SOURCES SOUGHT

CONTRACTOR INFORMATION FORM (Part II)

Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement. Submit a minimum of 1 or maximum of 5 projects. Please limit response to two pages per project.

1. Contractor Name:

2. Project No. (check one): - 1 - 2 - 3 - 4 - 5

3. Contract Number: Delivery/Task Order No.:

Project Number:

Title:

Location:

4. Award Date (mm/dd/yy): 5. Final Contract Price: ¥

Completion Date (mm/dd/yy): (incl. all options and mods)

Project is _____ % complete (on submission due date) This is the total project subcontract price.

6. Customer/Owner Name:

Point of Contact Name/Title: (person with project knowledge)

POC Phone Number: POC Email Address:

7. Were you the Prime contractor for this project? Yes No

Were you a subcontractor for this project? Yes No

If subcontractor, who was the Prime contractor?

8. Type of Contract (check all that apply):

Firm-Fixed Price Indefinite Delivery, Indefinite Quantity

Other (explain): _______________________________________________________________________

9. Type of Work:

Janitorial Pest Control Ground Maintenance Landscaping Change of Occupancy Maintenance Service

Painting Floor/Carpet Maintenance, repair, alteration, demolition and minor construction

Rental Service / Repair Service / Operation Service of Mobile Crane and Construction Equipment

Other (describe):

10. Narrative Description of the Project:

11. Percentage of work you self-performed on this project: _____%. Explain work self-performed:

Untitled

U.S. Commander Fleet Activities Yokosuka (CFAY), Japan