L-9_Pre-Award_Survey.doc

W911KB-13-R-0014

Attachment L-9

Attachment L-9 PRE-AWARD SURVEY (Submit for Volume 3, Section 2, Tab 2-1) FIRM NAME, ADDRESS, TELEPHONE and EMAIL:

CAGE Code:

TYPE OF BUSINESS:

FORMCHECKBOX

Individual FORMCHECKBOX Partnership FORMCHECKBOX

LLC FORMCHECKBOX

Joint Venture

FORMCHECKBOX

Corporation in the State of ______________________

SMALL BUSINSESS TYPE (mark all that apply): FORMCHECKBOX 8(a) FORMCHECKBOX HUBZone FORMCHECKBOX

SDVOSB FORMCHECKBOX

WOSB FORMCHECKBOX

EWOSB

Number of years firm has been in business: ____________ Corporate Officers/Personnel Authorized to Bind the Company (Provide name and email contact information):

DUNS # (used for accessing the Construction Performance Appraisal System (CPARS) Database):

Also provide any other assigned number that identifies the member firm(s) in the CPARS database. If a separate DUNS has been created for a joint venture (J-V) it must also be submitted. Provide a DUNS number for each company identified in any proposed Contractor-subcontractor association of firms. If the firm is a joint venture or contractor-subcontractor association of firms, list the individual firms and briefly describe the nature of the association. Provide DUNS for each.

Firm 1:

Firm 2:

Firm 3:

List current commitments with the expected completion date, dollar value, firm/agency, point of contact, and telephone.

List all pending lawsuits or unsatisfied judgments against your firm, the nature of same and Court where filed or adjudicated. Lawsuits or judgments where full payment will be made or are covered by your insurance are not to be included.

List all pending contract claims. State nature of claim, amount, and approximate date filed.

Signed: ____________________________________

Typed/Printed Name: ____________________________________

Title: ____________________________________

Date: _________________