Sources Sought Information Form.docx

SOURCES SOUGHT – CONTRACTOR INFORMATION FORM

NAVFAC NORTHWEST WEST SOUND MACC

SOURCES SOUGHT – CONTRACTOR EXPERIENCE DATA FORM

NAVFAC NORTHWEST WEST SOUND MACC

Use this form to provide contractor’s general information. Please limit response to one page. The box at the bottom of this form may be used to clarify any requested information.

1. Contractor Information:

Firm Name: __________________________________________________________________________

Address: ____________________________________________________________________________

Point of Contact Name: _________________________________________________________________

Phone Number of POC: _______________________ Email of POC: __________________________

UEI: _____________________ CAGE Code: _________________ UID: ____________________

CMMC Certification: _____________________________ Expiration Date: __________________

Is your firm registered in the System for Award Management (SAM) at https://www.sam.gov? |_| Yes |_| No. If not registered, you are advised that SAM registrations are taking much longer for approval. All prospective offerors, including Joint Ventures, are highly encouraged to start SAM registration.

2. Type of Business: (Check all which apply)

|_| SBA Certified 8(a) Firm |_| SBA Certified HUBZone

|_| Service-Disabled Veteran-Owned Small Business |_| Small Business

|_| Women-Owned Small Business (WOSB) |_| Other (Specify):_______________________

3. Bonding Capacity:

Surety Name: _________________________________________________________________________

Maximum Bonding Capacity Per Project: $__________________________

Aggregate Maximum Bonding Capacity: $__________________________

4. Locations:

Identify if your firm is willing and capable to work at various government installations located in Washington, Oregon, Idaho, Montana, Alaska, Iowa, Minnesota, North Dakota, South Dakota, Nebraska and Wyoming. However, it is anticipated that most projects will be performed in Washington State.

|_| Yes |_| No

If no, please provide an explanation: ____________________________________________________

5. This space may be used to provide any additional information to clarify the above items only:

Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement. Submit three (3) projects minimum, but no more than five (5). Please limit responses to two pages per project.

1. Contractor Name: ________________________________________________________________

2. Project No. (check one): |_| - 1 |_| - 2 |_| - 3 |_| - 4 |_| - 5

3. Contract Number: __________________________ Delivery/Task Order No.:______________

Project Number: __________________________

Title: ____________________________________________________________________________

Location: ________________________________________________________________________

4. Award Date (mm/dd/yy): ____________________

Completion Date (mm/dd/yy): _________________

Project is ______% complete (as of sources sought issuance date)

5. Final Contract Price: $___________________ (includes all options and modifications)

This is the |_| total project |_| subcontract price.

6. Type of Work:

|_| Other (explain):

7. Customer/Owner Name: __________________________________________________________

Point of Contact Name/Title: _______________________________________________________

POC Phone Number: ______________________ POC Email: ___________________________

8. Were you the Prime Contractor for this project? |_| Yes |_| No

Were you a Subcontractor for this project? |_| Yes |_| No

If Subcontractor, who was the Prime Contractor? __________________________________________

9. Type of Contract: (Check all that apply)

|_| Other (explain):

10. Describe the project’s key elements that demonstrate your firm’s experience with the type of work specified in the sources sought (NAICS):

11. Percentage of work you self-performed on this project: _____%

Provide a detailed description of the work your firm self-performed on this project: