Experience_Performance_Evaluation_Form.docx

Solicitation #: 12010918Q0013

Past Performance/Relevant Experience

Prime Contractor Information NOTE: This information and associated Questionnaires are due not later than 5 days prior to the quote due date.

The instructions below contain the minimum requirements but may not be all inclusive. Contractors must review the performance work statement, all attachments, instructions and the evaluation elements in order to determine relevant information to include.

1. Past Performance/Relevant Experience – Limited to one Relevant Experience form per project.

a. Provide at least three (3) but no more than five (5) relevant projects using the attached Relevant Experience form. All projects must have been performed within the past five (5) years for entities such as, but not limited to: local towns/villages/cities/municipalities and Boroughs, the State of Alaska, Regional Corporations, National Park Service, Bureau of Land Management, Forest Service, etc. All projects must be similar in nature to the geographic area being covered: remote wildland areas AND must demonstrate complexity such as, but not limited to: road systems longer than 5 miles, equipment troubleshooting and repairs made, multiple contractors in the working vicinity, etc. These experiences are considered by the Government to be more relevant for evaluation than those with other organizations on smaller road systems.

i. For at LEAST two (2) of the submitted projects, the quoter must have been serving as the prime contractor.

ii. At LEAST two (2) of the projects must have been for road brushing work.

Contractor performed as: ___ PRIME Contractor ___ SUB-Contractor (Check one) Project Title: _______________________________________________________________________________ Project Contract Number: _____________________________________________________________________ Briefly describe how this project meets/exceeds the criteria above:

Sensitive When Completed - FAR 2.101 and 3.104 -

Comments/Continuation (as needed)

Sensitive When Completed - FAR 2.101 and 3.104 -

PRIME CONTRACTOR INFORMATION:

By completing this form you are representing that the above information is accurate and true as of the date of the signature.

Company Name: ___________________________________

E-mail Address: ____________________________________________ Relevant Experience: Page 2 of 2