Attachment B - Specialized Experience Form (3 Pages).docx

SPECIALIZED EXPERIENCE FORM

SPECIALIZED EXPERIENCE FORM

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 a 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 the contract to the 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 the performance; steps were taken toward resolution

j. Describe unforeseen conditions and how each was resolved

k. Performance Period, including the 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 the percentage of completion, if not 50% completed for any reason, the rating may be lower.

n. The Offerors shall indicate if any of the contacts 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: