Specialized_Experience_Form.pdf

W912DS-15-R-0005, FIRE STATION, WATERVLIET ARSENAL, NY

SPECIALIZED EXPERIENCE FORM

PRIME CONTRACTOR OR ARCHITECT-ENGINEER FIRM

Offeror’s Name: _______________________________________________________________________

Project Name: ________________________________________________________________________

Project Location: ______________________________________________________________________

Project Size (i.e.; square foot area): ________________________________________________________

Project Description (scope and complexity): _________________________________________________

Facility Type (i.e.; fire station, emergency services, historic, renovation, etc.):

Role (i.e. prime, joint venture, subcontractor) and work Company/Firm self-performed on this project:

Project Award Amount: _________________ Project Completion Amount: ______________________

Project Original Contract Duration and Completion Date: ______________________________________

Project Final Contract Duration and Completion Date: _________________________________________

Client/Agency (if Government, give contract number and name of Contracting Officer):

Client/Agency Point of Contact, Phone Number and Address (if Government, give contract number and name of Contracting Officer):

List Project Prime Construction Contractor and Subcontractor(s):________________________________