ATTACHMENT 3 - Specialized Experience Form.pdf

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Attached to
(PROJ 675-24-106) BB Upgrade Lake Baldwin Pharmacy Hazardous Mixing Room - Construction
Solicitation number
36C24826Q0673
Issued by

About this file

This is a Specialized Experience Form template used to document contractor qualifications and past project performance in response to federal solicitations. The form requires offerors to submit exactly three (3) projects demonstrating relevant experience; submissions with fewer than three projects may receive lower ratings, and more than three will not be evaluated.

For each project, offerors must provide comprehensive information including: contractor details (firm name, address, DUNS number, CAGE code, contact information); contract/task order number and award date; project title and location; role classification (prime contractor, subcontractor, joint venture, or other); percentage of work performed by the offeror's company; prime contractor information if applicable; and government agency/contracting officer contact details. Additionally, offerors must describe the project scope and their specific roles and responsibilities in sufficient detail to demonstrate relevance to the solicitation requirements, including any difficulties, obstacles, or unforeseen conditions encountered and their resolutions. The form also requires performance period documentation (contract start date through completion or projected completion date), actual completion date with explanation if incomplete, confirmation that the project is at least 50% complete, indication of any contract terminations with reasons, and original versus final contract pricing with explanations of any differences.

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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 .