Sources Sought- Project Data Form 12.13.24.pdf

SOURCES SOUGHT –PROJECT DATA FORM

75N99025R000XX

Design-Build (DB)/Design-Bid-Build (DBB), Indefinite Delivery Indefinite Quantity (IDIQ)

Multiple Award Construction Contract (MACC) for NIH facilities within Maryland, North

Carolina, and Arizona

Use this form (one per project) to provide supporting information that demonstrates project experience relevant to the subject announcement. Submit up to five (5) projects. Please limit response 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): 5. Final Contract Price:

Completion Date (mm/dd/yy): (includes all options and mods)

Project is complete (as of submission due date) This is the total project subcontract price.

6. Type of work: New Construction Repair Renovation

7. Customer/Owner Name:

Point of Contact Name/Title:

(person with project knowledge)

POC Phone Number: POC Email Address:

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):

Design-Build Design-Bid-Build (fully designed project)

Other (explain):

If Design-Build, provide the following information: Design accomplished in-house

Lead design firm name: Years working together:

Address:

10. Provide a detailed description of the project:

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

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

Form may be expanded. Please DO NOT change content of the form.