Sources_Sought_Response_Form_-_NW_MACC_-_N4425515R0004.docx

SMALL BUSINESS RESPONSE FORM

SOURCES SOUGHT FOR N44255-15-R-0004

NAVFAC NORTHWEST MULTIPLE AWARD CONSTRUCTION CONTRACT

FOR NAVAL FACILITIES ENGINEERING COMMAND, NORTHWEST

(Please remember to save your electronic response as “(Insert Company Name) –NW MACC Sources Sought Response – N4425515R0004.doc” (or .docx or .pdf as appropriate). Email to shannon.meland@navy.mil no later than 25 November 2014. Also remember that the NAICS for this planned solicitation is 236220 and the small business size standard is $36.5 million.)

Firm Name:

Address:

Point of Contact Name: Phone: Email:

Is your firm registered in the System for Award Management (SAM) at https://www.sam.gov?

Yes No

If yes, please provide CAGE or DUNS used in Central Contractor Registration.

Type of Business: (Check all which apply for NAICS 236220)

SBA Certified 8(a) Firm

SBA Certified HUBZone

Service Disabled Veteran-Owned Small Business

Veteran Owned Small Business

Small Disadvantaged Business

Woman Owned Small Business

Small Business

Other Type of Small Business (Specify)

What is your firm’s bonding capacity?

Per Project $ Aggregate $

What would be your firm’s interest in proposing on the planned solicitation?

Very Likely Likely Not Likely

SAMPLE PROJECT 1

Contract Number:

Contract Title:

Contract Award Date:

Contract Completion Date:

Contract Customer:

Contract Type: (Check all that apply)

Were you the prime contractor for the project? YES NO

If not, who was the prime contractor?

What percent of the entire project did you complete?

Contract Total Price (Award amount plus all modifications):

Please check which of the following this contract included:

APPROACH

TYPE OF WORK:

WORK INCLUDED:

Narrative Description: Provide information on the project which demonstrates your firms prior experience with the requirements listed in the sources sought.

SAMPLE PROJECT 2

Contract Number:

Contract Title:

Contract Award Date:

Contract Completion Date:

Contract Customer:

Contract Type: (Check all that apply)

Were you the prime contractor for the project? YES NO

If not, who was the prime contractor?

What percent of the entire project did you complete?

Contract Total Price (Award amount plus all modifications):

Please check which of the following this contract included:

APPROACH

TYPE WORK

TYPE FACILITY

Narrative Description: Provide information on the project which demonstrates your firms prior experience with the requirements listed in the sources sought.

SAMPLE PROJECT 3

Contract Number:

Contract Title:

Contract Award Date:

Contract Completion Date:

Contract Customer:

Contract Type: (Check all that apply)

Were you the prime contractor for the project? YES NO

If not, who was the prime contractor?

What percent of the entire project did you complete?

Contract Total Price (Award amount plus all modifications):

Please check which of the following this contract included:

APPROACH

WORK INCLUDED:

Narrative Description: Provide information on the project which demonstrates your firms prior experience with the requirements listed in the sources sought.

SAMPLE PROJECT 4

Contract Number:

Contract Title:

Contract Award Date:

Contract Completion Date:

Contract Customer:

Contract Type: (Check all that apply)

Were you the prime contractor for the project? YES NO

If not, who was the prime contractor?

What percent of the entire project did you complete?

Contract Total Price (Award amount plus all modifications):

Please check which of the following this contract included:

APPROACH

WORK INCLUDED:

Narrative Description: Provide information on the project which demonstrates your firms prior experience with the requirements listed in the sources sought.

SAMPLE PROJECT 5

Contract Number:

Contract Title:

Contract Award Date:

Contract Completion Date:

Contract Customer:

Contract Type: (Check all that apply)

Were you the prime contractor for the project? YES NO

If not, who was the prime contractor?

What percent of the entire project did you complete?

Contract Total Price (Award amount plus all modifications):

Please check which of the following this contract included:

APPROACH

WORK INCLUDED:

Narrative Description: Provide information on the project which demonstrates your firms prior experience with the requirements listed in the sources sought.