* Refer ITA 14 for date and source of exchange rate. Form EXP - 4.2(a) Specific Construction and Contract Management Experience [The following table shall be filled in for contracts performed by the Applicant, each member of a Joint Venture, and Specialized Sub-contractors] Applicant's/Joint Venture Member's Name: [insert full name] Date: [insert day, month, year] JV Party Name: [insert full name] ICB No. and title: [insert ICB number and title] Page of pages [insert page number] [insert total number] Information Similar Contract No. of [insert number] [insert number of similar contracts required] Contract Identification [insert contract name and number, if applicable] Award date [insert day, month, year, i.e., 15 June, 2015] Completion date [insert day, month, year, i.e., 03 October, 2017] Role in Contract Prime Member in Management JV Contractor [check the appropriate box] Total Contract Amount US$ [insert total contract amount [insert in local currency] Exchange rate and total contract amount in US$ equivalent]* [insert a [insert total [insert exchange rate and If member in a JV or percentage contract total contract amount in US$ specify participation in amount] amount in local equivalent]* total Contract amount currency] Employer's Name: [insert full name] Address: [indicate street / number / town or city / country] Telephone/fax number [insert telephone/fax numbers, including country and city area codes] E-mail: [insert e-mail address, if available]
* Refer ITA 14 for date and source of exchange rate. Form EXP - 4.2(a) Specific Construction and Contract Management Experience [The following table shall be filled in for contracts performed by the Applicant, each member of a Joint Venture, and Specialized Sub-contractors] Applicant's/Joint Venture Member's Name: [insert full name] Date: [insert day, month, year] JV Party Name: [insert full name] ICB No. and title: [insert ICB number and title] Page [insert page number] of [insert total number] pages Similar Contract No. [insert number] of [insert number of similar contracts required] Information Contract Identification [insert contract name and number, if applicable] Award date [insert day, month, year, i.e., 15 June, 2015] Completion date [insert day, month, year, i.e., 03 October, 2017] Role in Contract [check the appropriate box] Prime Member in JV Management Contractor Total Contract Amount [insert total contract amount in local currency] US$ [insert Exchange rate and total contract amount in US$ equivalent]* If member in a JV or specify participation in total Contract amount [insert a percentage amount] [insert total contract amount in local currency] [insert exchange rate and total contract amount in US$ equivalent]* Employer's Name: [insert full name] Address: Telephone/fax number E-mail: [indicate street / number / town or city / country] [insert telephone/fax numbers, including country and city area codes] [insert e-mail address, if available]
PQandUsersGuide19Sep2011.docx