Attachment G Experience Information Sheet.pdf
PDF 396 KB Posted
- Solicitation number
- 36C24821R0111
About this file
This document contains an experience information sheet template and details of a federal contract opportunity for design-build services to create a Women's Center Imaging at the West Palm Beach VA Medical Center. The experience information sheet template requires contractors to provide details of past project experience including contract information, scope of work performed, performance period, difficulties encountered and resolutions, and pricing details. The related federal contract opportunity will provide up to $500,000 for design and construction services including demolition and construction of the Women's Center Imaging space. The solicitation will be issued on April 20, 2021 via FBO and all interested firms must be registered in SAM and VetBiz. The award is a firm-fixed-price contract and the work must be completed by December 2021.
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EXPERIENCE INFORMATION SHEET 36C24821R0008
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 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).
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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