J-4_Pre-Award_Survey.pdf

Document No.

P17PS01907

Document Title KLGO YMCA Design Build Fire Suppression System

Section J.1 Attachment J-4, Pre-Award Survey

ATTACHMENT J-4 PRE-AWARD SURVEY

PRE-AWARD SURVEY

Read carefully: The purpose of this form is for the offeror to provide the Government with information to assist the Contracting Officer in making a determination of offeror/bidder responsibility. This form shall be completed by the apparent successful offeror prior to award of any contract resulting from the issuance of Solicitation No.

P17PS01907 KLGO YMCA Design Build Fire Suppression System.

NAME OF CONTRACTOR/OFFEROR:

Business Address:

City/State/Zip Code:

Telephone Number:

OPERATING OFFICE ADDRESS (Local Area) (if different from above):

Business Address:

City/State/Zip Code:

Telephone Number:

TYPE OF ORGANIZATION (Please check the appropriate box)

Corporation (if incorporated please list state of incorporation_________) Partnership

Individual Joint Venture Limited Liability Company

List of Corporation Officers/Partners by Name and Title:

EXPERIENCE:

Number of Years’ Experience in the field of proposed work __________

Indicate similarity between work currently being produced and work required under subject invitation:

Document No.

P17PS01907

Document Title KLGO YMCA Design Build Fire Suppression System

Section J.1 Attachment J-4, Pre-Award Survey

ATTACHMENT J-4 PRE-AWARD SURVEY

FINANCIAL INFORMATION (note: Financial information is confidential; therefore, any financial information received from your company will not be released without your prior consent):

Attach to this survey a certified current balance sheet and latest profit and loss statement signed by an officer of the company; also include the name of your banking firm, their telephone number and the name of the individual to contact for a line-of-credit reference. The last financial statements will be acceptable if they are less than 6 months old.

Pending Lawsuits: List all pending lawsuits or unsatisfied judgments against you; the nature of same and Court where filed or adjudicated. Lawsuits or judgments where full payment will be made, or are covered by your insurance are not to be included.

Pending Contract Claims: List all pending contract claims; state nature and amount of each claim and approximate date filed.

BONDING & INSURANCE INFORMATION:

Surety

Name of Surety:

Address of Surety:

Name of Agent:

Bonding Capacity as established by your surety: $

Insurance Company

Name of Insurance Company:

Address of Insurance Company:

Name of Agent:

Types of Policies: