SSAttch2-Exp Questionnaire.pdf

ATTACHMENT 2

EXPERIENCE QUESTIONNAIRE

Project No. (check one): CON #1 CON #2 CON #3

1. Name of Entity that Performed Project: _________________________________________________________

Address: ____________________________________________________________________________________

Phone Number: __________________________________ SAM UEI: ________________________________

Point of Contact: _________________________________ Contact Phone Number: _____________________

a. If the Entity (named above) that performed the project has been acquired and is no longer a separate legal entity, provide the name of the Acquiring Firm and an explanation of the acquisition sufficient to demonstrate 1) that the

Entity is now part of the Acquiring Firm, and 2) that the Acquiring Firm currently possesses assets and personnel from the Entity sufficient for the Entity’s experience and past performance to be reasonably predictive of the

Acquiring Firm’s performance on this contract.

Name of Acquiring Firm: ____________________________________ UEI of Acquiring Firm: ______________

Acquisition Terms:

b. Name of Entity that Performed Work that Experience is Claimed for (i.e.; if the project was performed by a Joint

Venture (JV) and Offeror is claiming experience of one of the J/V members that performed work on the project, state the exact legal name of the JV member the Offeror claims experience for):

Address: ____________________________________________________________________________________

Phone Number: ___________________________________ SAM UEI: ________________________________

Point of Contact: __________________________________ Contact Phone Number: _____________________

2. Work Performed as*: Prime Contractor Sub Contractor Joint Venture Other

(Explain)

Percent of project work performed:

If subcontractor, who was prime (Name/Phone #):

3. Contract Number: Delivery/Task Order Number:

Title:

Location:

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

If not complete, % physically complete as of the date of issuance of this RFP:

5. Type of work: New Construction Renovation Repair Alteration Other (explain):

6. Type of Contract/Task Order: (Check ALL that apply)

Firm-Fixed Price Cost/Time and Material Other (explain):

7. Construction Project:

Total Construction Award Amount: $__________________ Final Construction Price: $_________________

Type of Contract/Task Order: (Check ALL that apply)

Design-Build Design-Bid-Build Delivery/Task Order (IDIQ) Other (explain):

8. Construction Project Details: Offerors shall complete the following information for each relevant individual feature: (For each item checked, provide a detailed description of the work in Block 9).

• New construction of Airfield Portland Cement Concrete (PCC) Pavement: Yes No o Area of Airfield PCC Pavement constructed:

_________ square meters with a minimum concrete thickness of ________mm.

o Was Airfield PCC Pavement for an aircraft runway, taxiway, or apron? Yes No

• New construction of Airfield Asphalt Concrete (AC) Pavement: Yes No o Area of Airfield PCC Pavement constructed:

_________ square meters with a minimum asphalt concrete thickness of ________mm.

o Was Airfield PCC Pavement for an aircraft runway, taxiway, or apron? Yes No

9. Provide a detailed description of the project and the relevancy to the project requirements of this RFP. (e.g.:

unique features, square footage, construction methods, any problems encountered and how it was resolved).