Att_04-_Form_1.pdf

Attachment 04- Form 1 P15PS00887- Road Restriping Offeror _______________________________________

FORM 1

EXPERIENCE AND PAST PERFORMANCE

Use this form to demonstrate your successful past experience of relevant jobs that compare favorably to the work offered in this project. Refer to the instructions in Section L, Instructions for the Submission of Offers and Other Information and Section M, Evaluation Factors for Award. List jobs of similar nature/scope as performed within the last three years. Use as many copies of this Form, or an equivalent, as may be required. Attach additional documents as needed.

PART I – FINANCIAL DATA

I.1 FINANCIAL DATA AS OF ________________ (date)

CURRENT ASSETS $_________________ Name of Bank: _________________

CURRENT LIABILITIES $_________________ Point of Contact: _________________

NET WORTH $_________________ Phone Number: _________________

PART II – EXISTING COMMITMENTS

II.1 CONTRACT NUMBER: AMOUNT:

AGENCY/OWNER:

CONTACT PERSON: PHONE NUMBER:

DESCRIPTION OF WORK (PROVIDE A BRIEF NARRATIVE INCLUDING MAJOR PROJECT TASKS,

MATERIALS USED, ETC.):

PERFORMANCE PERIOD:

P15PS00887- Road Restriping Offeror _______________________________________

II.2 CONTRACT NUMBER: AMOUNT:

AGENCY/OWNER:

CONTACT PERSON: PHONE NUMBER:

DESCRIPTION OF WORK (PROVIDE A BRIEF NARRATIVE INCLUDING MAJOR PROJECT TASKS,

PERFORMANCE PERIOD:

P15PS00887- Road Restriping Offeror _______________________________________

PART III – PAST PERFORMANCE & RELEVANT EXPERIENCE

III.1 CONTRACT NUMBER: AMOUNT:

AGENCY/OWNER:

CONTACT PERSON: PHONE NUMBER:

DESCRIPTION OF WORK (PROVIDE A BRIEF NARRATIVE INCLUDING MAJOR PROJECT TASKS,

III.2 CONTRACT NUMBER: AMOUNT:

CONTACT PERSON: PHONE NUMBER:

DESCRIPTION OF WORK (PROVIDE A BRIEF NARRATIVE INCLUDING MAJOR PROJECT TASKS,

MATERIALS USED, ETC.):

P15PS00887- Road Restriping Offeror _______________________________________

III.3 CONTRACT NUMBER: AMOUNT:

CONTACT PERSON: PHONE NUMBER:

DESCRIPTION OF WORK (PROVIDE A BRIEF NARRATIVE INCLUDING MAJOR PROJECT TASKS,

MATERIALS USED, ETC.):

III.4 LARGEST CONTRACT IN THE PAST THREE YEARS

CONTRACT NUMBER __________________________

CONTRACT AMOUNT __________________________

CONTRACT DATE __________________________

AGENCY/OWNER: __________________________

DESCRIPTION OF WORK: