Attachment B - Experience Information Sheet.pdf
PDF 133 KB Posted
- Attached to
- Y1DA--FY24: NRM (PROJ: 673-23-104) DB Install Fall Protection Anchorage and Guardrails for Bldg 1 and 2
- Solicitation number
- 36C24824R0016
About this file
This document contains an Experience Information Sheet template to be completed by offerors responding to solicitation number 36C24824R0016 from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8. The solicitation seeks offers to install fall protection anchorage and guardrails for Buildings 1 and 2 at Project 673-23-104. Offerors must use the sheet to provide details of relevant past performance including contract information, scope of work performed, completion dates, difficulties encountered, and pricing details. Items such as subcontracting roles, percentage of work performed, and contract terminations must also be addressed.
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Text version
EXPERIENCE INFORMATION SHEET 36C24823R0186
EXPERIENCE INFORMATION SHEET - See Factor 2 Subfactor C PROJECT NO. [673-14-104] Page 1
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. [673-14-104] 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. [673-14-104] 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:
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