W5J9JE-15-R-0028_ATTACHMENT_B_Experience_Form.docx

ATTACHMENT B

EXPERIENCE FORM

PROJECT No. (circle one): 1 2 3 4 5

Name of Offeror: _______________________________________________________________________________

E-mail Address: ________________________________________________________________________________

Telephone Number: _____________________________________________________________________________

Project Title: __________________________________________________________________________________

Contract Number: ______________________________________________________________________________

Contract Amount (U.S. Dollar Amount) $____________________________________________________________

Contract Completion Date: _______________________________________________________________________

Contract Duration (Period of Performance): __________________________________________________________

Description of the Project’s Scope and Magnitude: _____________________________________________________________________________________________

Location of Project: ___________________________________________________________________________

Details of your company’s role and activities during construction of the project: (describe your role in this project. Include whether your firm participated as a prime or as a subcontractor. SPECIFICALLY describe your roles and responsibilities in the design portion of the contract.