TACCOM_II_RELEVANT_EXPERIENCE_FORM.docx

Relevant Experience Form

PART I

Offeror Name:

Offeror DUNS:

Technical Category: ___TC1 ___TC2 Sub - Category: ______________________ Project #:____ of ____ (maximum of 3) Project/Award Title: ______________________________________________________

Any Relevant Experience information submitted must be in accordance with the instructions in Section L and must match the FPDS-NG record (not applicable for State/Local project) and all other supporting documentation listed below.

1. Award ID (Award Number(s)) (for a “collection of orders,” cite in order of highest to lowest): __________________________________________________

2. Contractor Name on Award: ___________________________________________

Contractor DUNS on Award: ___________________________________________

3. Date Signed (mm/dd/yyyy):Award Date: ______________________________

4. Reference IDV (if award was against an IDIQ/BPA): _______________________

5. NAICS (Code): ______________

6. Award Type: ________________________________________________________________

7. Contracting Agency(ies) (or State/Local Government entity) for which work was performed: _____________________________________

8. Obligated Amount **Must be $150K or greater**: ______________________

Obligated Amount for highest value order (for a “collection of orders” only):_________________

9. Period of Performance (MM/DD/YYYY):

Effective Date: ____________________

Completion Date: __________________

Estimated Ultimate Completion Date including all options: ____________________

10. Place(s) of Performance (Delivery/Service Locations in SOW/SOO/PWS):_______________________________

11. Contracting Officer (or equivalent position for State/Local) Name and Email: __________________________________________

12. Contracting Officer’s Representative (or equivalent position for State/Local) Name and Email: _____________________________

Part II

1. Contracting Agency is a federal agency, state government, or locality in the United States? (OCONUS for federal agency submission is acceptable if work was in a foreign nation but on a US government base/installation) __Y __N

2. Contractor (as indicated on the Award Form) was the prime contractor on the award:

__Y __N

3. Action Obligation is >$150K? __Y __N

4. Requirements on award match the selected Sub-Category (as identified on the top of page 1 of the Relevant Experience Form)? __Y __N

5. The relevant Sub-Category (page 1 of the Relevant Experience Form) is the majority (>51%) of the project requirement? __Y __N

6. Fully executed award document (SF 1449, or equivalent) attached? __Y __N

7. Statement of Work (or equivalent) attached? __Y __N

a) Yellow highlights in attached SOW clearly indicate requirements match the sub-category? __Y __N

b) Specific subcategory areas of delivery DHS sub-categories manually/electronically labelled in attached SOW and easily identified? (Note: Each sub-category must be clearly labelled and easily identified in order to claim credit on TacCom II Scoring Spreadsheet) __Y __N

c) Pink highlights in attached SOW indicate delivery/service locations? __Y __N

8. For Relevant Experience projects performed for a federal agency, final Federal Procurement Data System – Next Generation (FPDS-NG) Record (printed directly from FPDS-NG) or substitute verification document (as specified in Section L.7.2.3 of RFP) attached? __Y __N __ NA

9. The most recent Contractor Performance Assessment Report (CPAR) (printed directly from PPIRS) or Past Performance Rating Form (and at least 50% of the rated criteria is rated satifactory or higher) is attached? ** the last date of the period of performance being evaluated must be later than June 30, 2014. __Y __N

10. Contractor Name and DUNS on all the above documents match? (or qualifying exception below) __Y __N __Novation: Check here if novation is attached __ JV under the SBA’s ASMPP: Check here if supporting documentation is attached __Meaningful Relationship: Check here if Meaningful Relationship Commitment Letter is attached

11. All other information submitted in Part I of this form matches all of the above documents and attachments? __Y __N

12. Award ID listed in Part I matches all the above documents and attachments? __Y __N

13. Obligated Amount listed in Part I matches all the above documents and attachments? __Y __N

If answers to all the above questions are “Yes,” this project is qualified as relevant experience. Add this project to the TacCom II Scoring Spreadsheet. Completion of Part 3 of this form is not required.

If any answers to the above questions 1 through 10 are “No,” stop here. This project is not qualified as relevant experience and cannot be added to the TacCom II Scoring Spreadsheet.

If the answer to the above question 8 is “NA” and the project was performed with a state or local government entity, proceed to Part 3.

If the answer to the above question 11 is “No,” proceed to Part 3.

Part III

Offeror Request for CO Concurrence:

As an Offeror submitting a proposal under the Department of Homeland Security TacCom II Request for Proposal, records of our past performance (Relevant Experience Projects) must be submitted with our proposal for source selection validation. The TacCom II solicitation requires that, where FPDS information does not exist, or where uncorrected inconsistencies exist between the information submitted in Part I of this form and the contract documentation to be submitted in response solicitation, the cognizant CO or COR (or equivalent for State and Local) must provide concurrence with the information provided in Part I.

The following conditions have been identified, requiring CO or COR (or equivalent for State and Local) concurrence (place an X by applicable conditions):

___ Final FPDS does not exist because the contract is with a State or Local government entity.

___ Uncorrected inconsistencies (as listed below) exist between the information submitted in Part I of this form and the contract documentation to be submitted in response to the TacCom II solicitation (including reference contract award documents/modifications, FPDS, CPARS).

1. ________________________

2. ________________________

3. ________________________

4. ________________________

5. ________________________

CO Concurrence:

I hereby confirm that I am the Cognizant CO, COR or State/Local equivalent for the contract cited in the Award ID field in Part I of this form. I have confirmed that the data submitted in Part I of this form is true and accurate to the best of my knowledge. I further concur that any inconsistencies in the reference contract award documentation, as identified above by the Offeror, are administrative errors.

Signature:

Name:

Title:

Agency:

Email:

Phone: