DCRBPASTPERFORMANCEANDEXPERIENCEQUESTIONNAIRE

AppendixEtoSolicitation#DCRB-18-R-0003(StrategicPlanDevelopment)

INSTRUCTIONS:SeeBox11,Remarks,ifextraspaceisneededtoansweranyitembelow.Mark"X"inappropriateboxes. / 1.CONTRACTORNAME,ADDRESSANDTELEPHONENUMBER
2.SUBMITTEDTO:
DistrictofColumbiaRetirementBoard
9007thStreet,N.W.,SecondFloorWashington,DC20001 / 3.BUSINESS(Circletheappropriateresponse)
CompanyCo-partnership
CorporationIndividual
Non-profitOrganization / 4.How manyyearsdoyouoryourfirmhaveinthelineofworkcontemplatedbythissolicitation?
5.How manyyearsexperienceincontractinghaveyouoryourbusinesshadasa(a)primecontractorand/or(b)sub-contractor?
6.Listbelowtheprojectsyourbusinesshascompletedwithinthelastfive(5)yearswhicharesimilarinscopeandscaletothisjob.
CONTRACTAMOUNT / TYPEOFPROJECT / DATECOMPLETED / NAMES,ADDRESS,TELEPHONENO.ANDE-MAILADDRESSOFOWNER/PERSONTOCONTACTFORPROJECTINFORMATION
7.Listbelowallofyourfirm'scontractualcommitmentsrunningconcurrentlywiththeworkcontemplatedbythissolicitation:
CONTRACTNUMBER / DOLLARAMOUNT / NAME,ADDRESSSTELEPHONENO.ANDE-MAILADDRESSOFBUSINESS/GOVERNMENTAGENCYINVOLVED / AWARDED
(units) / PERCENTCOMPLETED / DATECONTRACTCOMPLETED
8a.Haveyoueverfailedtocompleteanyworkawardedtoyou?Yes No8b.Hasworkeverbeencompletedbyperformancebond?Yes No8c.If"Yes"toeitheritem8aor8bspecifylocation(s)andreason(s)why:

DCRBPASTPERFORMANCEANDEXPERIENCEQUESTIONNAIRE

AppendixEtoSolicitation#DCRB-18-R-0003(StrategicPlanDevelopment)

9.Organizationandworkthatwillbeavailableforthisproject:
a.(1)Minimumnumberof employees:and (2)Maximumnumberofemployees: _
b.Areemployeesregularlyonyourpayroll:YesNo
c.Specifyequipmentavailableforthiscontract:

d.Estimaterateofprogressbelow(suchas2.0acres/man/day):
(1)Minimumprogressrate:and (2)Maximumprogressrate:
10.Listbelowtheexperienceoftheprincipalindividualsofyourbusiness:
INDIVIDUAL'SNAME / PRESENTPOSITION / YEARSOFEXPERIENCE / MAGNITUDEANDTYPEOFWORK
11.REMARKS-SPECIFYBOXNUMBERS(Attachsheetsifextraspaceisneededtofullyansweranyoftheabovequestions.)
CERTIFICATION
Icertifythatallofthestatements madeby mearecompleteandcorrecttothebestofmyknowledgeandthatanypersonsnamedasreferencesareauthorizedtofurnishtheDistrictwithanyinformationneededtoverifymycapabilitytoperformthisproject. / 12a.CERTIFYINGOFFICIAL'SNAMEANDTITLE
12B.SIGNATURE(Signinink) / 13.DATE