S02_RFP Attachment Specialized Experience Form 3 pages.pdf

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Attached to
Z2DA--FY26 NRM (PROJ: 516-CSI-134) BB Prepare Site for Installation of a New PET/CT
Solicitation number
36C24826Q0459
Issued by

About this file

This is a Specialized Experience Form template used to document and evaluate prior contract performance as evidence of contractor qualifications for federal procurements.

The form requires offerors to submit a minimum of three projects but no more than five, with submissions of fewer than three projects resulting in lower ratings. For each project, offerors must provide: contractor information including firm name, address, DUNS number, CAGE code, and points of contact; contract and task order numbers with award dates; project title and location; work role designation (prime contractor, subcontractor, joint venture, or other); percentage of project work performed; prime contractor information if applicable; and government agency and contracting officer contact details. Offerors must describe the project scope, their specific roles and responsibilities, and demonstrate relevance to the current procurement requirement. Additional required information includes difficulties and obstacles encountered with resolution steps, unforeseen conditions and resolutions, performance period with start and completion dates, actual completion status, project completion percentage (with ratings potentially lower if below 50%), contract termination details if applicable, and original versus final contract pricing with explanations of any differences. Continuation sheets are permitted for detailed descriptions. The form serves as a standardized mechanism for evaluating contractor past performance and qualifications prior to contract award.

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SPECIALIZED EXPERIENCE FORM

SPECIALIZED EXPERIENCE INFORMATION SHEET

PROJECT NO. [ ] Page 1 Must have a Minimum of THREE (3) projects, but no more than 5 will not be evaluated; less than 3 projects will 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?

(Firm Name, Address, DUNS Number and Cage Code, Phone number, POC Name, POC email, Company email)

g. Government Agency/Company which 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:

File details come from the government source that posted it. Updated .