Sources Sought Contractor Information Form N6247326R0033.pdf

(Rev. 11/15)

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

for

MCAGCC TWENTYNINE PALMS, MCMWTC BRIDGEPORT, AND MCLB

BARSTOW, CA, AORS,

OTHER SPECIALTY TRADE CONTRACTORS PROJECTS IDIQ JOC

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: UEI: 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. Locations. Identify the locations you are willing and capable to work: (check all that apply)

MCLB BARSTOW AOR MCAGC 29PALMS AOR

MCMWTC BRIDGEPORT AOR

If you are not willing and capable to work in locations noted above, explain why not:

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

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

(Rev. 11/15)

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

for

MCAGCC TWENTYNINE PALMS, MCMWTC BRIDGEPORT, AND MCLB

BARSTOW, CA, AORS,

OTHER SPECIALTY TRADE CONTRACTORS PROJECTS IDIQ JOC

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 sources sought issuance 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

Other (explain):

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.