Attach_1_Questionnaire_Mod01.doc

QUESTIONNAIRE SUMMARY MATRIX

1. Company Name:

Address:

DUNS Number:

CAGE Code:

Point of Contact Name:

Point of Contact Phone Number:

Point of Contact Email Address:

2. Small Business Status (check all that applies) ____ Small

____ Self-Certified SDB ____ 8(a)

____ WOSB

____ HUBZone

____ VOSB

____ SDVOSB

3. Average Annual Receipts for Past 3 Fiscal Years: $________ (see FAR 19.101 for definition of “Annual Receipts”) FY 2020 Annual Receipts: $_____ FY 2019 Annual Receipts: $_____ FY 2018 Annual Receipts: $_____

4. For current active contracts, projected Annual Receipts for

FY 2021: $_____

FY 2022: $_____

5. State your current Line of Credit and your maximum Line of Credit

Current Line of Credit: $______ Maximum Line of Credit: $______

6. Describe how your firm has complied with FAR 52.219-14, Limitations on Subcontracting

7. Provide information on a minimum of three (3), maximum of five (5) relevant projects that demonstrate your experience/capability to perform the following work in tropical environments similar to Hawaii, Guam, and Pacific Ocean areas: (a) Execution of DD1391 or Similar Project Programming Document; (b) Functional Analysis Concept Development (FACD)/Design Charrettes; (c) Development of DB RFP Solicitation Documentation; (d) Development of DBB Design Contract Documents; (e) Mechanical Engineering Studies. Relevant projects include new construction/repair/alteration of 1) land based liquid petroleum fuels system facility or 2) building/facility mechanical systems. Land based liquid petroleum fuel facility is defined as a facility used for the receipt, storage, distribution, or dispensing of liquid petroleum fuels. Building/facility mechanical systems include heating, ventilation and air conditioning (HVAC) systems, refrigeration, plumbing, fire protection, fuel oil systems, steam systems, compressed gases industrial ventilation, radon mitigation and vacuum systems. Building/facility include, but not limited to, bachelor enlisted/officer quarters, fire station, fitness center, dining facility, auditorium/theater, retail store, school, office building, training facilities, communication buildings, aircraft hangar, maintenance shop, and warehouse, and armory. The ten (10) year completion timeline for relevant projects applies to design and engineering services and does not include PCAS services. New construction projects shall be $10 million or more in construction contract value (estimated or actual) per project and completed within the past ten (10) years. Repair/alteration projects shall be $5 million or more in construction contract value (estimated or actual) per project and completed within the past ten (10) years immediately preceding the date of issuance of this notice. For new construction and repair/alteration projects the minimum contract cost (estimate or actual) for the land based liquid petroleum fuel facility and the mechanical systems shall not be less than $4 million and completed within the past ten (10) years.

Contract Number:

Contract Type:

Total Dollar Value of Project:

Dollar Value of Work performed by the Prime:

Dollar Value of Sub-contracted Work:

Date/Duration of Contract:

Description of work and how it relates to the definition provided in Section 7 above.

Contract Number:

Total Dollar Value of Project:

Dollar Value of Work performed by the Prime:

Description of work and how it relates to the definition provided in Section 7 above.

Contract Number:

Total Dollar Value of Project:

Dollar Value of Work performed by the Prime:

Description of work and how it relates to the definition provided in Section 7 above.

8. Provide your firm’s experience with resourcing and managing varying workloads of multi-discipline Architect-Engineer (AE) services similar in scope as described in Section 7 above simultaneously. Please list the project titles, project description, dollar values and periods of performance.