Attachment 16_Project Verification Form.docx

Project Verification Form Attachment 16

PROJECT VERIFICATION FORM

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 Projects

· For Federal Government Projects,

· to substitute a FPDS report if it is not available, or

· the FPDS report does not substantiate all elements, or

· 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 Projects)

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

PART II: PRIME CONTRACTOR CERTIFICATION

By signing this section, the Customer named in this section certifies the Offeror identified in Part I performed the project stated in Part I

NAME:

TITLE:

AGENCY OR CUSTOMER:

EMAIL:

PHONE NUMBER:

SIGNATURE:

DATE:

PART III: CUSTOMER CERTIFICATION

By signing this section, the Customer named in this section certifies the Offeror identified in Part I performed the project stated in Part I

NAME:

TITLE:

AGENCY OR CUSTOMER:

EMAIL:

PHONE NUMBER:

SIGNATURE:

DATE:

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:

AGENCY OR COMPANY (If different than what was stated in Element 6 above):

EMAIL:

PHONE NUMBER:

SIGNATURE:

DATE: