Attachment 14_Project Verification Form_3rd Draft RFP.pdf

Project Verification Form Attachment 14

PROJECT VERIFICATION FORM (PVF)

In accordance with the addendums to 52.212-1 and 52.212-2, this attachment shall be completed for the following purposes:

● All Non-Federal and First-Tier Subcontract Federal and Non-Federal Projects (Ref.

Addendum to 52.212-1, para. 4.3.1.2.2),

● For Federal Government Projects (Ref. Addendum to 52.212-1, para. 4.3.1.2.1), o to substitute a FPDS report if it is not available, or o the FPDS report does not substantiate all elements, or o the Offeror does not believe the information was stated correctly on the FPDS report

State which elements are being substituted (Select all that apply)

1 2 3 4 5 6 7

Offeror fills out Parts I, II, and III. The Offeror is responsible for submitting one completed form for each project it is claiming, as applicable within the proposal.

Project Experience Prime Contractor Verification: In accordance with the addendums to 52.212-1 and 52.212-2, for an Offeror that provided service as a First-Tier subcontractor to obtain project experience verification using this form, this form must be sent to and signed by the Prime Contractor to verify the claimed project elements (qualifications). The Prime Contractor must provide verification within Part II of this form, verifying the Offeror performed the work detailed in Parts I. Please ensure all information is current, accurate and complete so that the PACTS III Contracting Officer may contact the individual in this Section.

Project Experience Customer Verification: In accordance with the addendums to 52.212-1 and 52.212-2, to obtain project experience verification using this form, this form must be sent to and signed by the cognizant Contracting Officer, Contracting Officer’s Representative, other Government employee, or Corporate Officer/Official (customer) to verify the claimed project elements (qualifications). The customer must provide verification within Part III of this form, verifying the Offeror performed the work detailed in Parts I. Please ensure all information is current, accurate and complete so that the PACTS III Contracting Officer may contact the individual in this Section.

Project Experience Offeror Verification: The Offeror shall sign Part IV of this form certifying it performed the project stated on this Project Verification Form and that all information provided on this form is current, accurate and complete. At any time, if the evaluation team discovers misleading, falsified or fraudulent proposal information, the Offeror may be eliminated from further consideration for award

PART I: ELEMENTS

ELEMENT 1: PROJECT TITLE

PROJECT NAME:

ELEMENT 2: PROJECT CONTRACT NUMBER

CONTRACT/ORDER NUMBER:

ELEMENT 3: TOTAL OBLIGATED VALUE

PROJECT OBLIGATION

AMOUNT:

ELEMENT 4: IN-SCOPE OF PACTS III

PROJECT PRINCIPAL NAICS:

PROJECT PRINCIPAL PRODUCT

SERVICE CODE (PSC):

ELEMENT 5: PERIOD OF PERFORMANCE

PERIOD OF PERFORMANCE

START DATE:

PERIOD OF PERFORMANCE END

DATE:

ELEMENT 6: OFFEROR’S NAME

UNIQUE ENTITY ID:

LEGAL BUSINESS NAME:

CAGE CODE:

ELEMENT 7: PAST PERFORMANCE

(Only applicable to Non-Federal and First-Tier Subcontract Federal and Non-Federal Projects)

SATISFACTORY DEFINITION: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

RATING SELECTION (please place an “X” next to the selected rating)

____ Contractor performed at a satisfactory (or above) level of performance in accordance with the above definition.

____ Contractor performed below a satisfactory level of performance in accordance with the above definition.

PART II: PRIME CONTRACTOR CERTIFICATION

(Only applicable to Non-Federal and First-Tier Subcontract Federal and Non-Federal Projects)

By signing this section, the Prime Contractor named in this section certifies that it agrees with all the information identified in Part I and that the Offeror’s performance for this project was/is satisfactory or above

NAME:

TITLE:

COMPANY NAME:

EMAIL:

PHONE NUMBER:

SIGNATURE:

PART III: CUSTOMER CERTIFICATION

By signing this section, the Customer named in this section certifies that it agrees with all the information identified in Part I and that the Offeror’s performance for this project was/is satisfactory or above

NAME:

TITLE:

CUSTOMER NAME:

EMAIL:

PHONE NUMBER:

PART IV: OFFEROR CERTIFICATION

By signing this section, the Offeror certifies it performed the project stated on this Project Verification Form and that all information provided on this form is current, accurate and complete.

OFFEROR REPRESENTATIVE’S

NAME:

TITLE:

EMAIL:

PHONE NUMBER:

Project Verification Form (PVF) Instructions

ELEMENT SUBSTITUTION

If the PVF is being used by an Offeror that is submitting a Federal project that is performed as a Prime Contractor, the Offeror shall include a “x” in all the boxes next to the elements it is using the PVF to substitute. Except for element 7, this Offeror shall still complete the PVF in its entirety, even if the elements are not being substituted.

Part I. ELEMENTS

Element 1. PROJECT TITLE All Offerors using the PVF shall include the title of its project.

Element 2. PROJECT CONTRACT NUMBER All Offerors using the PVF shall include the contract number exactly as it appears on the contract document for the project.

Element 3. TOTAL OBLIGATED AMOUNT All Offerors using the PVF shall include the total obligated amount of its project. Reference addendum to 52.212-1, paragraph 4.3.1.1.1(c) for guidance.

Element 4. IN-SCOPE OF PACTS III All Offerors using the PVF shall include the NAICS code and Product Service Code for its project.

For federal projects that the Offeror performed as a Prime Contractor and not a first-tier subcontractor, the Offeror shall include the NAICS and Product Service Code (PSC) that is on the FPDS-NG report. If the Offeror believes the NAICS/PSC stated on the FPDS-NG report was incorrectly stated, the Offeror shall include the NAICS/PSC it believes it should be. The NAICS/PSC must align with the predominant service being provided for the project (Ref.

Addendum to 52.212-1, paragraph 4.3.1.2.1(d).

For non-federal projects and projects that the Offeror performed as a first-tier subcontractor, either federally or non-federally, the Offeror shall include a NAICS and PSC that most closely aligns with the predominant service that it provided for that specific project (Ref.

https://www.census.gov/naics/ and Functional Category NAICS/PSC Relationships, Attachment 2). The NAICS/PSC must align with the predominant service being provided for the project

Element 5. PERIOD OF PERFORMANCE All Offerors using the PVF shall include the period of performance of its project. Reference addendum to 52.212-1, paragraph 4.3.1.1.1(e) and 4.3.1.1.2 for guidance.

Element 6. OFFEROR’S NAME All Offerors using the PVF shall include its name exactly as it appears on the contract document for the project.

Element 7. PAST PERFORMANCE https://www.census.gov/naics/

Only Offeror that are using the PVF for non-federal projects and projects that the Offeror performed as a first-tier subcontractor, either federally or non-federally projects are required to complete this section. The Prime Contractor of the project that the Offeror performed on shall state whether the Offeror’s performance as a first-tier subcontractor was satisfactory by putting an “X” in the appropriate box.

Part II. PRIME CONTRACTOR CERTIFICATION Only Offerors that are using the PVF for non-federal projects and projects that the Offeror performed as a first-tier subcontractor, either federally or non-federally projects are required to complete this section. The Prime Contractor of the project that the Offeror performed on shall complete this section. By doing so, this Prime Contractor is agreeing with the content stated in Elements 1-7.

Part III. CUSTOMER CERTIFICATION All Offerors have this part of the form completed by its customer in accordance with the addendum to 52.212-1, paragraphs 4.3.1.2.1(d)(ii) or 4.3.1.2.2(c). By doing so, the Customer is agreeing with the content stated in Elements 1-7.

Part IV. OFFEROR CERTIFICATION All Offerors complete this part of the form. By doing so, the Offeror is agreeing with the content stated in Elements 1-7.