Attachment 4 Experience Reporting Form.docx
DOCX document 23 KB Posted
- Attached to
- Disability Evaluation Services
- Solicitation number
- PANHCA-26-P-0000-032241
- Issued by
-
Department of the Army Medical Command
About this file
This is an Experience Reporting Form template for the Disability Evaluation Services (DES) solicitation issued by the Department of the Army Medical Command. The form requires prospective contractors and their teaming partners or subcontractors to document up to three (3) projects each, demonstrating a minimum of 24 months of relevant experience completed within the previous 36 months. Projects must be of the same or similar type and scope to Support Staff Services.
For each project, respondents must provide comprehensive information including the firm name, contract number and title, contract type and pricing arrangement, detailed work description, relevance to the DES acquisition, the contractor's role (prime, joint venture, or subcontractor), contract award amount, contract dates (beginning and completion), and disclosure of any terminations or assessed liquidated damages. The form allows for specification of which portions of past contracts are relevant if only portions apply to the immediate acquisition. This template serves as a mechanism for evaluating contractor experience and capability to support the U.S. Army MEDCOM DES Program Office in strategic, operational, and tactical analysis, planning, programming, and implementation of disability evaluation solutions at Defense Health Headquarters in Falls Church, Virginia and Joint Base San Antonio in Texas.
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Other files
| File | Type | Posted |
|---|---|---|
| OTSG DES - Attachment 3 Questions and Answers - 06252026.docx | DOCX document | |
| Attachment 2 Market Research Questionnaire.docx | DOCX document | |
| Attachment 1 OTSG_DES PWS.docx | DOCX document | |
| Attachment 3 Questions and Answers Template .docx | DOCX document |
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Text version
Attachment 4 - SOURCES SOUGHT – DISABILITY EVALUATION SERVICES
EXPERIENCE REPORTING FORM
EXPERIENCE REPORTING FORM
Provide the following information to show up to three (3) examples of projects each for your company and your teaming partner/subcontractor completed for a total of 24 months of the previous 36 months indicating experience with projects of same or similar type and scope to Support Staff Services. Use one form per project.
Project No. 1
a. Name of Firm:
b. Contract Number, Title, and Location of Project:
c. Contract Type and Pricing Arrangement:
d. Type of Work/Description of the job:
e. Describe how the contract referenced is relevant to the immediate acquisition. If only portions of the contract are relevant, specify which portions of the contract are relevant to the immediate acquisition:
f. Role (Prime, Joint Venture, or Subcontractor, etc.):
g. Contract or Subcontract (Award) Amount:
h. Dates of Contract: Began: Completed:
i. Were You Terminated or Assessed Liquidated Damages? yes no. If “yes”, provide explanation:
Project No. 2
b. Contract Number, Title, and Location of Project:
c. Contract Type and Pricing Arrangement:
d. Type of Work/Description of the job:
Nature of the Contractual Effort or Items Purchased:
e. Describe how the contract referenced is relevant to the immediate acquisition. If only portions of the contract are relevant, specify which portions of the contract are relevant to the immediate acquisition:
f. Role (Prime, Joint Venture, or Subcontractor, etc.):
g. Contract or Subcontract (Award) Amount:
Project No. 3
b. Contract Number, Title, and Location of Project:
c. Contract Type and Pricing Arrangement:
d. Type of Work/Description of the job: Describe how the contract referenced is relevant to the immediate acquisition. If only portions of the contract are relevant, specify which portions of the contract are relevant to the immediate acquisition:
f. Role (Prime, Joint Venture, or Subcontractor, etc.):
g. Contract or Subcontract (Award) Amount:
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