N6247319R1211_P1018_Sources__Sought_Info__Form.doc

SOURCES SOUGHT INFORMATION FORM FOR

NAVFAC SOUTHWEST

P 1018 AIRCRAFT IMPROVEMENTS

NORTH ISLAND AIR STATION (NASNI)

NAVAL BASE CORONADO, CA

1. Contractor Information:

Firm Name: _________________________________________________________________________

Address: ____________________________________________________________________________

Name of POC for firm: ________________________________________________________________

Phone Number of POC: ________________________________________________________________

Email Address of POC: ________________________________________________________________

2. Type of Business:

FORMCHECKBOX

SBA certified 8(a) firm FORMCHECKBOX SBA certified HUBZone

FORMCHECKBOX

Service-Disabled Veteran-Owned Small Business FORMCHECKBOX Woman-Owned Small Business

FORMCHECKBOX

Small Business

3. Bonding Capacity:

Surety Name: ________________________________________________________________________

Maximum bonding capacity per project: _______________________________

Aggregate maximum bonding capacity: ____________________________

Please DO NOT change content of the form.

4. Experience:

Provide supporting project information for experience with construction of new facilities used for office, administrative, testing, warehousing, secure compartmented information facilities (SCIF), and open secure storage facilities in a coastal environment as outlined on the Sources Sought Notice (no more than two single sided pages per project).

Project No. (check one): FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

Contract Number, Delivery/Task Order Number, Project Number, Title, and Location:

Were you the Prime contractor for this project? FORMCHECKBOX Yes FORMCHECKBOX No

Were you the Subcontractor? FORMCHECKBOX Yes FORMCHECKBOX No If subcontractor, who was the Prime? _____________

Award Date:

Completion Date:

Final Price (Including all options & mods):

Is this the total project FORMCHECKBOX or subcontract price FORMCHECKBOX

Type of work: FORMCHECKBOX Repair and Replacement FORMCHECKBOX Other- provide description of work

Please DO NOT change content of the form.

Type of Contract: (Check all that apply)

FORMCHECKBOX

Design-Build FORMCHECKBOX Design-Bid-Build

FORMCHECKBOX

Other (explain): ___________________

If Design-Build, provide:

Name/address of the lead design firm or if design was done in-house please specify:

Name: ___________________________________________________________________________

Address: ___________________________________________________________________________

How many years working together? ______________________________________________________

Provide brief description or scope of work for this project:

What work did your company self perform?

Customer/Owner Information:

Customer Name: ______________________________________________________________________

Point of Contact: ______________________________________________________________________

Phone Number: _______________________________________________________________________

Email Address: _______________________________________________________________________

Please DO NOT change content of the form.