TACCOM_II_RELEVANT_EXPERIENCE_FORM.docx

8/30/17

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):___________________________________________________

2. Contractor Name on Award :___________________________________________ Contractor DUNS on Award :___________________________________________

3. Award Date: ______________________________

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

5. NAICS (Code): ______________

6. Award Type: ________________________________________________________________

7. Contracting Agency (Federal/State/Local): ________________________________

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

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

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

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: _____________________________

Relevant Experience Form

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 (>50%) 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 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. Federal Procurement Data System – Next Generation (FPDS-NG) Record (printed directly from FPDS-NG) attached? (not applicable for State/Local) __Y __N

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

10. Contractor Name and DUNS on all the above documents match? (or qualifying exception) __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. Award ID listed in Part I matches all the above documents and attachments? __Y __N

12. 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.

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 (or equivalent for State/Local)(IF NECESSARY) SEE RFP