attachment D Experience Information Sheet.pdf
PDF 180 KB Posted
- Attached to
- Z1DA--FY22 Tier 2: NRM (PROJ: 548-22-140) DB Upgrade CLC Hospice Outbuildings Transformer
- Solicitation number
- 36C24822R0082
About this file
This document contains an experience information sheet template for contractors to submit past project experience relevant to Solicitation Number 36C24822R0082 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8. Contractors must provide details for a minimum of two and maximum of four past projects, including contractor information, contract details, work performed as prime contractor or subcontractor, percentage of work performed, description of scope and roles, performance period, completion status, original and final contract prices, and any contract terminations. The solicitation seeks installation of a new 750 KVA, 13200 V to 480Y/277 V transformer to serve Building 3 and additional buildings at a VA medical center, with no response date or period specified. Relevant experience in electrical infrastructure projects and transformer installation is required.
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EXPERIENCE INFORMATION SHEET
PROJECT NO. [ ] Page 1 Must have a total of four (2) projects, more than 2 will not be evaluated; less than 2 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 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).
Attachment D
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
PROJECT NO. [ ] 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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