W9128F25R0014 - Pre-Award Survey.pdf
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- Solicitation number
- W9128F25R0014
About this file
This is a pre-award survey form (W9128F25R0014) used to collect detailed information about construction contractors. The four-page form includes sections for capturing basic contractor information, organizational structure, personnel data, equipment ownership, and financial data.
The form contains three main schedules: Schedule A tracks existing commitments for projects between $5M-$10M, Schedule B documents completed construction projects from the past six years (including DoD contracts), and Schedule C inventories construction/technical equipment owned by the contractor. Key data points collected include current assets/liabilities, net worth, largest contract values, types of services rendered (construction/design/consultant), payroll personnel numbers, and equipment details including condition and years of service. This form appears to be part of the evaluation process for the USDA Dairy Forage Research Center construction project valued between $25M-$100M.
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Text version
W9128F25R0014
PRE-AWARD SURVEY
CONSTRUCTION CONTRACTOR DATA DATE:
Firm Name and Telephone Number Main Office Address (Street, City, and State)
Branch Offices Services Rendered
(a) Construction _
(b) Design _
(c) Consultant _
Organization _Individual _ Joint Venture Partnership Corporation
Date Organized Date Incorporated:
State:
Names of Officers and Other Key Personnel
I – PRESENT PAYROLL PERSONNEL (List Number of Each Category Below) Partners:
Officers:
Other Key:
Remainder: Subtotal Permanent:
Maximum Personnel at Any Time:
Date:
Total:
II—EQUIPMENT OWNED III—FINANCIAL DATA AS OF
(DATE): Present Value ($) Current Assets:
Acquisition Cost ($) Current Liabilities:
Net Worth:
IV—TOTAL VALUE OF CONSTRUCTION AND DEMOLITION WORK
IN PAST 6 YRS EXCLUSIVE OF JOINT VENTURE (LIST MOST
RECENT FIRST)
V—LARGEST JOB EVER
CONTRACTED
(If Other Than in Past Six Years)
$ LARGEST JOB IN PAST 6 YRS Contract Amount:
Date:
Description:
Owner:
$ Contract Amount:
Date:
Description:
Owner:
Avg. Annual Income
VI—TYPE OF WORK IN WHICH FIRM SPECIALIZES
NAME AND POSITION/TITLE OF PERSON SIGNING SIGNATURE
See attachment for explanations or detailed description of item(s) reported above.
CONSTRUCTION CONTRACTOR DATA – SCHEDULE A – EXISTING COMMITMENTS
List below the construction projects your firm currently has under way between $5M and $10M. Also list construction projects for which your firm is the apparent successful offeror/bidder, but for which a contract has not yet been awarded.
CONTRACT
NUMBER
CONTRACT
AMOUNT
DESCRIPTION/
LOCATION
ORGANIZATION/
CONTACT PERSON/
PHONE NUMBER
PERCENT
COMPLETE
CONSTRUCTION CONTRACTOR DATA – SCHEDULE B – COMPLETED PROJECTS
List below the principal construction projects your firm has completed within the past six years, including all DoD contracts.
CONTRACT
NUMBER
CONTRACT
AMOUNT
DESCRIPTION/
LOCATION
ORGANIZATION/
CONTACT
PERSON/ PHONE
NUMBER
PERCENT
SUBCONTR
ACTED
CONSTRUCTION CONTRACTOR DATA – SCHEDULE C –
CONSTRUCTION AND/OR TECHNICAL EQUIPMENT
List total equipment and facilities owned for performing the prospective contract and present status as to whether or not it is currently committed to existing contracts.
QUANTITY DESCRIPTION CONDITION YEARS OF
SERVICE
PRESENT
STATUS
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