ATTACHMENT L-3 SECTION L (AMENDED).pdf

MOAB RAC – FINAL RFP – PROJECT COMPLETION SECTION L

SOLICITATION NO. 89303320REM000066 – AMENDMENT 0001 (AMENDED)

L-3-1

Attachment L-3

Past Performance Reference Information Form

(Completed Form limited to seven pages per reference contract. If the reference contract is/was a subcontract to a prime contract, the information contained within this L-3 form shall only pertain to the subcontract information. If the reference contract is for the operation and/or demolition of a commercial facility, the L-3 form may be utilized to reflect the contract or binding agreement with one single client for the referenced services performed.)

Past Performance Reference Information Form

1. Name and DUNS # of Offeror Submitting

Proposal:

2. Name and DUNS # of Company for which

L-3 Form is being submitted:

3. Name of Reference Contract Client (e.g., Government Agency or Prime Contractor):

4. Name and DUNS # of Entity Reference

Contract Was Awarded To: (if the Entity was made up of member companies, provide the applicable member company’s name and

DUNS # as well)

5. Reference Contract Number:

Reference Contract Title:

6. Reference Contract Available in CPARS

(i.e., Yes/No):

7. Reference Contract Client Point of Contact:

*The reference point of contact must include the

Contracting Officer (or equivalent), and may also include the Project Director or Contracting

Officer’s Representative (or equivalents).

Name:

Title:

Telephone:

Email:

Address:

8. Reference Contract Period of Performance:

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Past Performance Reference Information Form

9. Reference Contract Period of Performance

Start Date:

10. Reference Contract Period of Performance

End Date:

11. Reference Contract Type (e.g., FP, T&M, CPFF, CPIF, CPAF, IDIQ, etc.):

12. Reference Contract Total Value and

Approximate Average Annual Value

(separately list fee if cost-type):

13. Reference Contract Value Performed To

Date (Insert the final sum of all invoices, or the sum of all invoices to date, including agreed upon and disputed amounts, paid and awaiting payment; Date = RFP release date):

14. Approximate Average Annual Value (in $) the Company (identified in #2) is planned to perform on Moab Remedial Action Contract:

15. Scope Company (identified in #2) is proposed to perform on Moab Remedial

Action Contract. List applicable PWS elements:

16. Scope Company (identified in #4) performed on Reference Contract:

17. Complexity Company (identified in #2) is proposed to perform on Moab Remedial

Action Contract:

18. Complexity of work Company (identified in

#4) performed on Reference Contract:

L-3-3

Past Performance Reference Information Form

19. Safety statistics: provide Days Away, Restricted or Transferred and Total

Recordable Case (TRC) rates and hours worked for the company (identified in #4) on the Reference Contract by Government

Fiscal Year (GFY) completed within the last

5 years from the Moab Remedial Action

Contract original solicitation issuance date :

20. For the Reference Contract, identify any

DOE enforcement actions and/or worker safety and health, nuclear safety, and/or classified information security incidents or notifications posted to the DOE Office of

Enterprise Assessments (EA) website

(https://energy.gov/ea/information-center/enforcement-infocenter) within the last 5 years from the Moab Remedial Action

Contract original solicitation issuance date and corrective actions taken to resolve those problems:

21. Was the reference contract awarded to an affiliated company (see definition of

“affiliates” at FAR 2.101) of the entity for which the L-3 form is being submitted

(identified in #2)? (Yes/No) If the name and/or DUNS are different than the entity identified in #2, explain the relationship (e.g., self, subsidiary, parent, etc.).

If “yes”, the Offeror shall describe the resources of the parent, member, or affiliated company that will be provided or relied upon in contract performance such that the parent, member, or affiliate will have meaningful involvement in contract performance.

https://energy.gov/ea/information-center/enforcement-infocenter https://energy.gov/ea/information-center/enforcement-infocenter

L-3-4

Past Performance Reference Information Form

If a common parent company is being used to establish the nexus between the Offeror and an affiliated company, then the Offeror must describe how the affiliate and Offeror rely on, for example, similar assets, resources, policies, and procedures of the common parent company.

If the Offeror identifies past performance information for predecessor companies that existed prior to any mergers or acquisitions, the Offeror shall demonstrate that such performance reasonably can be predictive of the Offeror’s performance.

Note: The Offeror may amend the format for Attachment L-3, “Past Performance Reference

Information Form”, as long as the exact information, font and size (per DOE-L-2001), and page limitations are followed. Also, the information contained in the Offeror’s submitted L-3 forms shall be consistent with the information contained in other sections of the Volume II proposal.