Attachment J-5 - Self Certification Technical Experience Form Amendment 0001.docx

ATTACHMENT J-5 –

SELF CERTIFICATION TECHNICAL EXPERIENCE FORM

Offeror fills out Parts I, II, and III. The Offeror is responsible for submitting the completed form with the claimed Qualifying Solution or Project within the proposal.

RFP No. 70RDA226R00000001 Amendment 0001 Attachment J-5 Self Certification Technical Experience Form

PART I: OFFEROR INFORMATION

OFFEROR NAME:

OFFEROR UEID:

PART II: TECHNICAL EXPERIENCE

For Track 1 (Hardware/Software) and Track 2 (C-UAS as a Service), the Offeror should mark in the matrix below if they have provided solutions that have aligned with the Functional Capabilities and the detailed use cases of Fixed Location or Mobile. They also should note if they have provided solutions for an Aviation or Maritime environment. Offerors must submit an associated completed Project Form (Part III of Attachment J-5) for each solution marked in the Part II matrix. Part III can be reused for each solution.

For Track 2, (System Integration), and (Research and Development (R&D) and Test and Evaluation (T&E) Support), the Offeror should mark in the matrix below if they have provided services that have aligned with the Functional Capabilities and the detailed use cases of Fixed Location or Mobile. They also should note if they have provided an associated service for an Aviation or Maritime environment. Offerors must submit an associated completed Project Form (Part III of Attachment J-5) for each solution marked in the Part II matrix. Part III can be reused for each solution.Please make sure that each marked solution has an associated completed Project Form, which can be reused for each proposed service.

Please replicate the chart below for each proposed Solution. For example, if the Offeror proposes Track 1 (Hardware), Track 2 (C-UAS as a Service), and Track 2 (System Integration), they should provide three (3) completed Matrices.

TRACK AND SOLUTION INFORMATION

Fixed Location #2 Fixed Location (Aviation) #3 Fixed Location (Maritime) #4 Mobile #5 Mobile (Aviation) #6 Mobile (Maritime)

Detect and Track (DT)

Identification (I)

Detect, Track, and Identification (DTI)

Mitigate/Neutralize (M)

Detect, Track, Identification, and Mitigate/Neutralize (DTI&M)

PART III: SOLUTION DETAIL

For each solution noted in the Technical Experience in Part II, Offerors shall provide information below detailing how they have experience in providing the solutions. This information shall include a narrative explaining the solution and how it demonstrates your ability to meet the associated Functional Capability and Use Case. Please make sure that each marked solution has an associated completed Project Form, which can be reused for each project.

PROJECT FORM

PRIME OFFEROR NAME:

FIRM NAME THAT PERFORMED THIS PROJECT (PRIOR EXPERIENCE FIRM)

ROLE THAT THE PRIOR EXPERIEINCE FIRM HAS WITH THE PRIME OFFEROR FOR THE PROPOSED CUAS CONTRACT WITH DHS

FOR AFFILIATE EXPERIENCE (INCLUDING BUT NOT LIMITED TO PARENT COMPANIES), THE OFFEROR MUST PROVIDE DETAILS ABOUT HOW THE AFFILIATE MEETS THE DEFNITION OF AFFILIATE IN FAR 2.101 AND HOW THE AFFILIATE’S RESOURCES WILL MEANINGFULLY CONTRIBUTE TO THE PRIME CONTRACTOR’S PERFORMANCE OF THE CUAS CONTRACT

FOR FIRST-TIER SUBCONTRACTORS UNDER 13 CFR 125.2(G), THE OFFEROR MUST PROVIDE DETAILS ABOUT THE SUBCONTRACTOR’S SIZE STATUS, AND IDENTIFY EXPERIENCE GAPS OF THE PRIME OFFEROR SUCH THAT THE PRIME OFFEROR’S EXPERIENCE DOES NOT INDEPENDENTLY DEMONSTRATE CAPABILITIES NECESSARY FOR AWARD

CONTRACT/ ORDER NUMBER (if applicable):

FUNCTIONAL CAPABILITY:

USE CASE:

PROJECT NAME:

DESCRIPTION OF SOLUTION:

NARRATIVE:

PRODUCTS UTILIZED (include brands, names, and quantity)

TOTAL PERIOD OF PERFORMANCE, INCLUDING OPTIONS: (MM/YYYY – MM/YYYY

or MM/YYYY – Present)

TOTAL CONTRACT OR ORDER VALUE:

AGENCY OR CUSTOMER:

NAME OF CONTRACTING OFFICER/COR OR CORPORATE/GOVERNMENT

OFFICIAL/REPRESENTATIVE (required):

TITLE:

EMAIL (required):

PHONE NUMBER (required):