Attachment_4_19AQMM18R0250_CTA_Template.docx

19AQMM18R0250

Functional Area 2 Contractor Teaming Arrangement Template

CONTRACTOR TEAMING ARRANGEMENT (CTA) TEMPLATE

(An existing Joint Venture or Partnership for an Other than Small Business CTA, or a Small Business CTA)

General: This form shall be sent to the members of the Offeror's existing or previous Contractor Team Arrangement (CTA) to validate the Offeror's performance under a project awarded to the CTA. This form shall be signed by a majority of members in the CTA, excluding the offeror. The Government will use this information solely for source selection purposes.

CTA Members: You are receiving this form because the Offeror cited in Part I claims that they performed the project identified in Part II as a member of your CTA and is using the project as relevant experience for its INL-WHP IT Services IDIQ, as either (a) an other-than-small business existing Joint Venture or Partnership proposal, or (b) a Small Business CTA proposal.

By signing this form in Part IV you are certifying that the Offeror was the only CTA member that performed the project and that no other CTA member, or the CTA, shall claim credit for this project. By completing this form, you are not required to make changes to any existing documents or systems related to the project awarded to your CTA. If you have any questions about this document, please email weakley-lugokf@state.gov.

Offeror: Part I, II, and III shall be completed by the Offeror. To complete this form, place the cursor in the highlighted area and begin typing. All responses in Part II, III and IV shall match what is entered into the corresponding Attachment 1 (Relevant Experience (PSC Group) Project Template) or Attachment (Relevant Experience Biometrics and Cloud). After completing Parts I, II, and III, the Offeror shall send this form to the CTA members and shall be signed by at least the majority of members, excluding the Offeror.

PART I: OFFEROR AND CTA INFORMATION

PART II: PROJECT IDENTIFICATION

PART III: OFFEROR CERTIFICATION

I certify that the Offeror identified in Part I was the only CTA member that performed the project identified above.

NAME:

TITLE:

EMAIL:

PHONE NUMBER:

PART IV: CTA MEMBER CERTIFICATION

Each CTA member shall have a Corporate Officer certify by signing below that they are a member of the CTA identified in Part I, and that the Offeror stated in Part I was the only CTA member that performed the project and that no other CTA member, or the CTA, shall claim credit for this project identified in Section II. Each CTA Member that chooses to sign this form will fill out one of the CTA Member boxes, sign and date and send back to the Offeror.

CTA Member #1:

CTA MEMBER NAME:

CTA MEMBER DUNS:

I certify that the Offeror identified in Part I was the only CTA member that performed the project identified above.

NAME:

TITLE:

EMAIL:

PHONE NUMBER:

PART IV: CTA MEMBER CERTIFICATION (Continued)

CTA Member #2:

CTA MEMBER NAME:

CTA MEMBER DUNS:

I certify that the Offeror identified in Part I was the only CTA member that performed the project identified above.

NAME:

TITLE:

EMAIL:

PHONE NUMBER:

CTA Member #3:

CTA MEMBER NAME:

CTA MEMBER DUNS:

I certify that the Offeror identified in Part I was the only CTA member that performed the project identified above.

NAME:

TITLE:

EMAIL:

PHONE NUMBER:

CTA Member #4:

CTA MEMBER NAME:

CTA MEMBER DUNS:

I certify that the Offeror identified in Part I was the only CTA member that performed the project identified above.

NAME:

TITLE:

EMAIL:

PHONE NUMBER:

PART IV: CTA MEMBER CERTIFICATION (Continued)

CTA Member #5:

CTA MEMBER NAME:

CTA MEMBER DUNS:

I certify that the Offeror identified in Part I was the only CTA member that performed the project identified above.

NAME:

TITLE:

EMAIL:

PHONE NUMBER: