Sources Sought - Project Data Form.pdf

SOURCES SOUGHT –PROJECT DATA FORM

75N99025R000XX

Multi-Discipline Architect- Engineer (AE) Services- Indefinite Delivery Indefinite Quantity

(IDIQ) Multiple Award Task Order Contract (MATOC) and Other Professional Services of an

Architectural or Engineering Nature Blanket Purchase Agreement (BPAs) 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 three 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 Service (check all that apply):

Design-Build Request for Proposal (RFP)

Design-Bid-Build (fully designed project)

Construction Quality Management (CQM)

Commissioning (Cx) Services

Other (explain):

If Design-Build RFP, provide the percentage of Design-Build RFP: ______%

10. Provide a detailed description of the project:

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