RFQ Appendix E - DOE-SR Experience Form.pdf

Department of Energy

Realty Agreement for Carbon

Pollution-Free Electricity Projects at Savannah River Site

Request for Qualifications (RFQ)

Appendix E - Past Performance

Reference Information Form

Appendix F

Past Performance Reference Information Form

(Utilizing this appendix, provide requested information of the most recent and relevant work completed or in progress by the Offeror of projects that are similar in scope and scale to the Offeror’s proposed Project (no more than 3 examples). Completed Form limited to three pages per reference project).

Past Performance Reference Information Form

1. Name of Offeror Submitting

Proposal:

2. Reference Project Client Point of Contact:

Name:

Title:

Telephone:

Email:

Address:

3. Project Location:

4. Project Generation Type (e.g.:

Solar, Wind, etc.):

5. Land (acres):

6. Project Nameplate Capacity and

Generation:

7. Project Start and End Date (Specify Construction Period and Operation Period):

8. Project Description:

9. Describe design, construction, management, and operation of the Project:

10. Describe the financing for the Project:

11. Cost of the Project:

12. Describe off-take agreements for the Project:

13. Describe Offeror’s specific role and activities in the Project (specifically state how the Offeror accomplished them directly or if they were

Past Performance Reference Information Form accomplished by another party, list the name of said other party):

14. Complexity of work Company performed on Reference Project:

15. Describe Safety Performance (For the reference project, the Offeror shall identify Occupational Safety and Health Administration (OSHA) safety statistics [e.g., Days Away, Restricted, or Transferred (DART) cases and Total Recordable Cases (TRC)], as well as any significant worker safety and health incidents. If similar projects are not within the last 5 years, provide DART and TRC rates for the company within the last 5 years):

Note: The Offeror may amend the format for the Appendix, Past Performance Reference Information Form, as long as the exact information, font and size, and page limitations are followed. Also, the information contained in the Offeror’s submitted forms shall be consistent with the information contained in other sections of their proposal.