Attachment 6 Experience Information Sheet.pdf
PDF 169 KB Posted
- Attached to
- DB 23-AP-0518 FY23 NRM-TIER 1 PROJ 548-22-118 UPGRADE AND REPAIR VARIOUS SITE CONDITIONS
- Solicitation number
- 36C24823R0101
About this file
This document contains an experience information sheet template and details of a federal contract solicitation for upgrade and repair services. The solicitation is set aside for SDVOSB, VOSB, and small businesses and issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8. The contractor shall provide all labor, materials, tools, and design-build services necessary to upgrade deteriorated loading dock equipment and gates, pressure jet storm drains, and upgrade exterior lighting and gazebos at the West Palm Beach Veterans Affairs Medical Center campus. Work is to include replacement of loading dock gates, pressure jetting of storm drains, and upgrades to gazebos and exterior lighting sconces. The objective is to upgrade and repair various deficiencies at the facility. The response is due by date not provided in the document.
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EXPERIENCE INFORMATION SHEET
PROJECT NO. [ ] Page 1 Must have a total of four (4) projects, more than 4 will not be evaluated; less than 4 may result in a lower rating.
a. Contractor Information of Awarded Contract (Firm Name, Address, DUNS Number, Phone number, POC Name, POC e‐mail, Company e‐mail)
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 or Subcontractor
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).
VHATAMFigliS Cross-Out
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 page for additional information, if necessary.
PROJECT NO. [ ] Page 3
i. Describe any difficulties and/or obstacles encountered during project performance; steps taken toward resolution
j. Describe differing site condition(s) occurrence(s) 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 (mm/dd/yyyy): Original completion date (mm/dd/yyyy):
l. Actual Completion Date (mm/dd/yyyy), and if not completed, why?
Actual Completion Date:
m. Attesting the example project is 100% complete? YES [ ]
n. The Offerors shall indicate if any of the example project provided was 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:
PROJECT NO. [ ] Page 4
CONTINUATION PAGE:
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