S02 - Attachment_15_Experience Info Sheet (MANDATORY)_(4 Pages).docx

DOCX document 28 KB Posted

Attached to
Y1LB--Replace AMA Bridge Federal contract opportunity
Solicitation number
36C24823R0017
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8

About this file

This document contains an experience information sheet template and notice of a pre-solicitation for design-build services. The experience information sheet is a mandatory attachment for offerors to provide details on up to four relevant past projects. It requests information on the contractor, contract and task order details, work performed as prime or subcontractor, percentage of work, government agency and point of contact awarded to, scope of work, difficulties encountered, performance period, completion status and date, original and final contract values, and any terminations.

The related pre-solicitation notice is for replacement of an existing pedestrian bridge at the VA Caribbean Healthcare System in San Juan, Puerto Rico. The design-build project value is estimated between $1 million to $2 million, with requirements for design, construction, fencing, and bridge removal. The solicitation will be issued on November 25, 2022. Responses are due January 3, 2023. The opportunity is set aside for Service-Disabled Veteran-Owned Small Businesses. Interested parties must register in SAM.gov and be verified in VIP database to be eligible as an SDVOSB. The Department of Veterans Affairs Veterans Health Administration VISN 8 is the agency.

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36C24823R0017 Pre-solicitation (Replace AMA Bridge).docx DOCX document
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Text version

EXPERIENCE INFORMATION SHEET

ATTACHMENT 15

SOL 36C24823R0017

REPLACE AMA BRIDGE

EXPERIENCE INFORMATION SHEET

PROJECT NO. [ ] Page 1 Must have a total of four (4) projects, more than 4 will not be evaluated; less than 4 may result in a lower rating.

a. Contractor Information of awarded contract (Firm Name, Address, DUNS Number and Cage Code, Phone number, POC Name, POC email, Company email)

b. Contract and/or Task Order Number and Award Date (mm/dd/yyyy)

c. Project Title/Name and Location

d. Work Performed as: Prime Contractor, Subcontractor, Joint Venture, Other (explain)

e. Percent (%) of project work performed by your company

f. If you work as subcontractor, who was the prime? Comment by Carla May: Should be a capital “I’ to if (Firm Name, Address, DUNS Number and Cage Code, Phone number, POC Name, POC email, Company email)

g. Government Agency/Company who awarded contract to offeror, and Contact Information, such Contracting Officer/Procurement Official/Point of Contract (Name, Title, Email, Phone Number).

EXPERIENCE INFORMATION SHEET

PROJECT NO. [ ] Page 2

h. Description of project’s scope of work and the offeror’s specific roles and responsibilities in the project: Describe work performed in sufficient detail to permit evaluation of project relevancy to this procurement. Detail how work performed is relevant to the effort required by the solicitation? Use continuation sheet for additional information, if necessary

EXPERIENCE INFORMATION SHEET

PROJECT NO. [ ] Page 3

i. Describe any difficulties and/or obstacles encountered during performance; steps taken toward resolution

j. Describe unforeseen conditions and how each were resolved

k. Performance Period, including contract start date (mm/dd/yyyy), and original completion date, if not completed, projected date (mm/dd/yyyy) contract start date:

original completion date, if not completed, projected completion date (mm/dd/yyyy)

l. Actual Completion Date (mm/dd/yyyy), and if not completed, why?

Actual Completion Date:

If not completed, Why?

m. Project is 50% or more complete? YES [ ] No [ ]. If “No” explain percentage of completion, if not 50% completed for any reason, rating may be lower.

n. The Offerors shall indicate if any of the contracts listed were terminated and the type and reasons for the termination.

o. Original Contract Price (Award Amount), Final Contract Price (to include all modifications, if applicable), Explain Differences.

Original Contract Price: Final Contract Price:

Explain Differences:

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