Attachment 10 - Specialized Experience Form.pdf

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Attached to
Y1DZ--(PROJ: 573-19-614) BB Correct Electrical Panelboard Defic. at Bldg 1
Solicitation number
36C24822R0157
Issued by

About this file

This document contains a specialized experience form and details of a federal contract opportunity for electrical panelboard corrections. The specialized experience form requests information on three past projects including contractor and subcontractor details, government customers, descriptions of scope and responsibilities, performance periods, outcomes, budgets, and terminations if applicable. The related federal contract opportunity is a solicitation from the Department of Veterans Affairs to correct electrical panelboard deficiencies at Building 1. Interested vendors must visit the site on August 10th and submit proposals by August 31st. This requirement is set aside for Service-Disabled Veteran-Owned Small Businesses.

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SPECIALIZED EXPERIENCE FORM

SPECIALIZED EXPERIENCE INFORMATION SHEET

PROJECT NO. [ ] Page 1 Must have a total of THREE (3) projects, more than 3 will not be evaluated; less than 3 may 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 .