TACCOM_II_RELEVANT_EXPERIENCE_FORM.docx

Relevant Experience Form

PART I

Offeror Name:

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 and all other supporting documentation listed below.

1. Award ID (Award Number):___________________________________________________

2. Contractor Name on Award :___________________________________________________

3. Award Date: ______________________________

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

5. NAICS (Code) **Must be 334220, 334515, 541330, 811213, or 517410**: ______________

6. Award Type: ________________________________________________________________

7. Contracting Agency **Must be a federal agency**: ________________________________

8. Action Obligation (Obligated Amount) **Must exceed $500K**: ______________________

9. Period of Performance **Completion date must be later than June 30, 2014**: ______________________________________________________

10. Place(s) of Performance (Delivery/Service Locations):_______________________________

11. Contracting Officer Name and Email: __________________________________________

12. Contracting Officer’s Representative Name and Email: _____________________________

Relevant Experience Form

Part II

1. Contracting Agency is a federal agency? __Y __N

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

3. Action Obligation is >$500K? __Y __N

4. NAICS (Code) on award document is 334220, 334515, 541330, 811213, or 517410? __Y __N

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

6. The relevant Category (page 1 of the Relevant Experience Form) is the majority (>50%) of the project requirement? __Y __N

7. Fully executed award document (SF 30, SF 1449 or equivalent) attached? __Y __N

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

a) Yellow highlights in attached SOW clearly indicate requirements match Category and technical sub-categories? __Y __N

b) Specific DHS technical 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

9. Federal Procurement Data System – Next Generation (FPDS-NG) Record (printed directly from FPDS-NG) attached? __Y __N

10. The most recent FAR compliant Contractor Performance Assessment Report (CPAR) (printed directly from PPIRS) or Past Performance Rating Form is attached? __Y __N

11. Contractor Name on all the above documents match? (or novation document attached) __Y __N __Check here if novation is attached

12. Award ID on all the above documents match? __Y __N

13. Action Obligation amount listed in Part I is evident in the above documents? __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.

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

CO or COR Signature (IF NECESSARY) SEE RFP, FPDS-NG UNAVAILABLE, INCOMPLETE OR INACCURATE