Attachment_16_-_Corporate_Experience_Form.docx

EXPERIENCE INFORMATION

(To be completed by Contractor)

1. Contractor:

Name:

Address:

2. Contract/Task Order(TO) /Purchase Order (PO) Number:

3. Contract/TO/PO Dollar Value:

4. Contract/TO/PO Status: Active or Complete Completion Date (w/ extensions):

5. Project Title:

Location:

6. Project Description -- to include the role of the contractor on the project and specific responsibilities of the contractor in performance of the effort:

7. Project Owner or Project Manager for the Client - provide:

Name:

Address:

Telephone Number and E-mail: