ATTACHMENT_A_-_PREAWARD_SURVEY_INFORMATION_W912P617B0008.pdf
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- Attached to
- Lake Street Sanitary and Storm Sewer Improvements Section 219, Gary, Lake County, Indiana
- Solicitation number
- W912P617B0008
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THIS FILE CONTAINS ATTACHMENT A - PREAWARD SURVEY FORM
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PREAWARD SURVEY INFORMATION
(RE: Subparts 9.104-1 and 9.105-1 of the Federal Acquisition Regulation)
CONTRACTOR NAME: _____________________________
SOLICITATION W912P6-17-B-0008, GSD, LAKE STATION, GARY, IN
Please complete the below form to assist in the completion of a Pre-award Survey:
1. Month and Year started in business:______________________
2. Year and State Incorporated:____________________________
3. Key Personnel:
President/Owner :__________________________________
Vice President/Partner:______________________________
Secretary/Treasurer:________________________________
4. Number of Full-Time Employees:________________________
5. Surety:
Agency:__________________________________________
Agent:____________________________________________
Address, City & State:_______________________________________
Telephone#:_______________________________________
6. Insurance Company:
Agency:__________________________________________
Agent:____________________________________________
Address, City & State:_______________________________________
Telephone#:_______________________________________
7. Financial Institution Information:
Name of Bank:_____________________________________
Contact Person:_____________________________________
Address, City & State:_______________________________________
Telephone#:________________________________________
ATTACHMENT A
8. References: Provide the names and contact information of three references. Information obtained from references will be used to determine if you have been diligent in the following areas: a) Quality of Work; b) Timely Performance; c) Effectiveness of Management; d) Compliance with Safety Standards; and e) Compliance with Labor Standards.
9. Does your company have any ongoing projects that may cause a problem with completing or beginning performance of the subject project?
10. Does your company have the necessary equipment to accomplish this project or the ability to obtain the necessary equipment?
END OF FORM
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