Attachment 4 - Self Certification Technical Expertise Form.docx

ATTACHMENT 4

SELF CERTIFICATION TECHNICAL EXPERTISE FORM

Offeror fills out Parts I, II, and III. The Offeror is responsible for submitting the completed form with the claimed Qualifying Solution or Project within the proposal.

Part IV - Customer Certification/Signature is completed by the referenced customer and provided

PART I: OFFEROR INFORMATION

OFFEROR NAME:

OFFEROR UEID:

PART II: TECHNICAL EXPERTISE

Offeror should mark in the matrix below if they have provided solutions that have aligned with the Functional Capabilities and the detailed use cases of Fixed Location or Mobile. They also should note if they have provided solutions for an Aviation or Maritime environment.

Fixed Location #2 Fixed Location (Aviation) #3 Fixed Location (Maritime) #4 Mobile #5 Mobile (Aviation) #6 Mobile (Maritime)

Detect and Track (DT)

Identification (I)

Detect, Track, and Identification (DTI)

Mitigate/Neutralize (M)

Detect, Track, Identification, and Mitigate/Neutralize (DTI&M)

PART III: SOLUTION DETAIL

For each solution noted in the Technical Expertise in Part II, Offerors should provide information below detailing how they have experience in providing the solutions. This information include a narrative explaining the solution and how it demonstrates your ability to meet the associated Functional Capability and Use Case. Please make sure that each marked solution has an associated completed Project Form, which can be reused for each project.

PROJECT FORM

OFFEROR NAME:

CONTRACT NUMBER (if applicable):

FUNCTIONAL CAPABILITY:

USE CASE:

PROJECT NAME:

DESCRIPTION OF SOLUTION:

NARRATIVE:

PRODUCTS UTILIZED (include brands, names, and quantity)

ORDER NUMBER (if applicable):

TOTAL PERIOD OF PERFORMANCE, INCLUDING OPTIONS: (MM/YYYY – MM/YYYY

or MM/YYYY – Present)

TOTAL CONTRACT OR ORDER VALUE:

PROJECT NAICS/PSC Code (if applicable):

FUNDING AGENCY ID OR CUSTOMER:

PART IV: CUSTOMER CERTIFICATION

For each Solution detailed in Part III, please provide the associated Customer information. Please make sure that each Project Form has an associated completed Customer Form, which can be reused for each project.

For non-federal projects: Corporate Officer/Official of the commercial entity with cognizance over the submitted project.

CUSTOMER FORM (NON-FEDERAL)

By signing this section, the Contracting Officer or Corporate Official named in this section certifies the Contractor identified in Part I performed the project as detailed in Parts II and III.

PROJECT NAME:

NAME OF CONTRACTING OFFICER OR CORPORATE

OFFICIAL (required):

TITLE:

EMAIL (required):

PHONE NUMBER (required):

AGENCY OR CUSTOMER:

SIGNATURE OF CONTRACTING OFFICER OR CORPORATE OFFICIAL:

DATE:

For federal projects: Contracting Officer with cognizance over the submitted project. For federal projects: If Contracting Officer signature is not available, then Contracting Officer Representative, or other Government representative with cognizance over the submitted project.

CUSTOMER FORM (FEDERAL)

By signing this section, the COR or Government representative named in this section certifies the Contractor identified in Part I performed the project as detailed in Parts II and III.

PROJECT NAME

NAME OF COR OR OTHER GOVERNMENT REPRESENTATIVE:

TITLE:

EMAIL:

PHONE NUMBER:

AGENCY OR CUSTOMER:

SIGNATURE OF COR OR GOVERNMENT REPRESENTATIVE:

DATE: