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Sources Sought Contractor and Experience Forms

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SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

for Nationwide MARFORRES Hazardous and nonHazardous Waste Disposal and Environmental Services

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:
DUNS:
CAGE Code:
Firm Name:
Address:
Name of POC for firm:
Phone Number of POC:
Email of POC:

2. Type of Business: (check all that apply)

|_| SBA certified 8(a) firm
|_| SBA certified HUBZone Small Business
|_| Service-Disabled Veteran-Owned Small Business
|_| Small Business

|_| Economically Disadvantaged Women-Owned Small Business

3. Bonding Capacity:

Surety Name:
Maximum bonding capacity per project:
$
Aggregate maximum bonding capacity:
$

4. This space may be used to provide any additional information to clarify the above items only:

Please DO NOT change content of the form.

SOURCES SOUGHT –EXPERIENCE PROJECT DATA FORM

for Nationwide MARFORRES Hazardous and nonHazardous Waste Disposal and Environmental Services

Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement. Submit up to five (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):
(includes all options and mods)
Project is % complete (as of submission due date)
This is the |_| total project |_| subcontract price.
6.
Type of work:
|_| New Construction|_| Repair|_| Renovation
7.
Customer/Owner Name:
Point of Contact Name/Title: (person with project knowledge)
POC Phone Number:
POC Email Address:
8.
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?
9.
Type of Contract (check all that apply):

|_| Design-Build |_| Design-Bid-Build (fully designed project)

|_| Other (explain):
If Design-Build, provide the following information:
|_| Design accomplished in-house
Lead design firm name:
Years working together:
Address:

10. Provide a detailed description of the project:

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

Provide a detailed description of the work your firm self-performed on this project:

Form may be expanded. Please DO NOT change content of the form.

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