Exhibit_C_FORM_C-1_Lower_Tier_Experience_Statement.doc

Ex C Form C-1 (Rev. 1, 9/22/08) Exhibit C Form C-1 Lower Tier Experience Statement

EXHIBIT “C”

FORM C-1

LOWER-TIER EXPERIENCE STATEMENT

This Form C-1 statement of experience qualifications is submitted for the following lower-tier supplier or subcontractor:

COMPANY NAME:

PHONE:

CONTACT:

FACSIMILE:

ADDRESS:

1.

This company has been engaged in the contracting business under its present business name for years.

2.

Experience in work of a nature similar in type and magnitude to that set forth in the Request for Proposal extends over a period of ____ years.

3.

Awarded contracts have been satisfactorily completed, except as follows (Name any and all exceptions and reasons therefore, attaching additional pages if necessary):

PN: In the following item, include the required number of years in the space provided.

4.

The following contracts, covering work similar in type and magnitude to that set forth in the Request for Proposal, have been satisfactorily completed within the last three years.

5.

Table completion notes:

Work Description:

Describe work scope and then indicate if prime or subcontract.

Start/Stop:

Provide starting date and actual/forecast completion by month/year format (e.g., Jan 2006/Sep 2007).

Schedule and Budget:

State either “over”, “on”, or “under” schedule and budget.

THIS FORM IS PRIMARILY FOR BID EVALUATION HOWEVER IS NOT PRECLUDED FROM BECOMING PART OF A RESULTANT SUBCONTRACT.

PR # RFP-0000476

August 27, 2019