Work Experience 22R0039.docx
DOCX document 13 KB Posted
- Solicitation number
- W912CN-22-R-0039
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Text version
WORK EXPERIENCE INFORMATION
Work experience information form to be completed by offeror. The contractor shall provide a completed work experience form which will show relevant work experience in the last five (5) consecutive years of experience in such services within the State of Hawaii to perform preventive maintenance and repair services for chillers, chemical / non-chemical water treatment, cooling towers, and heat pump systems. Has five or more years of experience in actual on-site testing of systems similar to the condenser water systems within the State of Hawaii. Provide at a minimum, at least one (1) completed Work Experience Form to be included with contractor’s proposal.
NOTE: The offeror is responsible for reproducing copies of this form.
1. Name of Offeror/Bidder: ______________________________
2. Name of Reference/Customer: ______________________________ Phone No.: ___________________________ Fax No.:_____________________________ Email: ________________________________________________________
3. Contract Number: ______________________
4. Project Title: _________________________________________________________________
5. Brief description of scope of work (to include assessment history and validation):
6. Period of Performance:
Base Year: Dates_____________________________ $ __________________ 1st Option: Dates_____________________________ $ __________________ 2nd Option: Dates____________________________ $ __________________ 3rd Option: Dates_____________________________ $ __________________ 4th Option: Date_____________________________ $ __________________ Total Contract Amount: $ __________________
7. Contract performed as: [ ] Prime Contractor [ ] Joint Venture Partner [ ] Sub-Contractor [ ] Key Personnel
8. Contract was: [ ] Firm-Fixed-Price [ ] Fixed-Price-Incentive [ ] Cost-Plus-Award-Fee [ ] Cost-Plus-Incentive-Fee [ ] Cost-Plus-Fixed-Fee
9. Offeror’s/Bidder’s statement on problems, if any, encountered during performance of work and any corrective actions taken to resolve problems. If no problems encountered, state NONE.
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