Technical Information Form.doc

Technical Information Form 1 This form must be completed and submitted for EACH project.

Technical Evaluation Factor 1 - Recent and Relevant Experience Project Information

Project Name/Number: _________________________________________________

Project Contract Number: ___________________________________

Facility Owner/Organization Name: _______________________________________________

Address: _________________________________________________________________ Facility Owner/Organization Point of Contact: _______________________________________

Facility Owner/Organization e-mail address: _______________________________________

Facility Owner/Organization Phone Number: _______________________________________

If work was performed as a subcontractor, please provide the following information:

Prime Contractor Name: _______________________________________________

Address:

Prime Contractor Point of Contact: _______________________________________

Prime Contractor e-mail address: _______________________________________

Prime Contractor Phone Number: _______________________________________

Award Amount: $_________________ Contract Award Date: _______ Completion Date: _______________

Factor 1 Elements covered:___________________ Project Scope: ______________________________________________________________________________

Percent of work completed by your own workforce based on contract award amount, and indicate specific work performed: ______________________________________________________________________________

Source Selection Information

See FAR 2.101 and 3.104

(Applicable when filled-in)