NB686060-21-00958 Atch C -Experience Submittal Form.docx

NB686060-21-00958 Rapid Cooldown Cryostat System Attachment C

EXPERIENCE SUBMITTAL FORM

1. Project No. (check one) : |_| #1 |_| #2 |_| #3 |_| #4

2. Experience for: |_| Offeror |_| Joint-Venture |_| Other (Explain)

Firm Name:

Address:

Phone Number:

Point of Contact: Contact Phone Number:

3. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other (Explain)

Percent of project work performed:

If subcontractor, who was prime (Name/Phone #):

4. Contract Number: Delivery/Task Order Number:

Title:

Location:

Award Amount:

Final Price:

5. Award Date (mm/dd/yy): Completion Date (mm/dd/yy):

6. Type of work:

7. Type of Contract/Task Order: (Check ALL that apply)

|_| Firm-Fixed Price |_| Cost/Time and Material |_| Other (explain):

8. Customer/Owner Name:

Point of Contact (POC): POC Phone Number:

FAX Number: POC E-mail address:

9. Provide a detailed description of the project and the relevancy to the project requirements of this RFQ

10. Other Information:

*Individual blocks on this form may be expanded; however, total length for each project data sheet shall not exceed one (1) double-sided page (or two (2) single-sided pages).