06. REVISED Work Sample Cover Sheet.docx

Attachment 6 – FA877322R0005 Solicitation

WORK SAMPLE COVER SHEET

PART I: WORK SAMPLE IDENTIFICATION

CONTRACTOR NAME

CONTRACT NUMBER

TASK ORDER NUMBER (if applicable)

CUSTOMER

PERIOD OF PERFORMANCE

WORK SAMPLE VALUE

SUBCONTRACT NUMBER

SPECIALTY AREA REFERENCE # See PWS for 31 Specialty Areas

WORK SAMPLE IDENTIFIER WS1-WS62 per Cross-Reference Matrix.

NUMBER OF PAGES IN WORK SAMPLE including cover page & signed contract document

PART II: WORK SAMPLE INFORMATION/POINTS OF CONTACT

1. Contracting Officer

NAME:

TITLE:

AGENCY or CUSTOMER

PHONE

E-MAIL:

2. Contracting Officer’s Representative or Relevant Customer Point of Contact

NAME:

TITLE:

AGENCY or CUSTOMER

PHONE

E-MAIL:

3. Prime Company Point of Contact #1

NAME:

TITLE:

COMPANY

PHONE

E-MAIL:

Prime Company Point of Contact #2

NAME:

TITLE:

COMPANY

PHONE

E-MAIL:

PART III: WORK SAMPLE DESCRIPTION (500 Character Limit)

PART IV: DEVIATION EXPLANATION

Instructions to Attachment 6 – Work Sample Cover Sheet This instruction page should not be submitted with Work Sample in Proposal Submission.

Offerors shall follow the instructions below when filling out Work Sample Cover Sheet.

PART I: WORK SAMPLE IDENTIFICATION

Contractor Name: Offerors shall enter the Contractor’s Name of this work sample.

Contract Number: Offerors shall enter the Contract Number.

Task Order Number: Offerors shall enter the Task Order Number (if applicable).

Customer: Offerors shall enter the agency, organization, or client name. If the customer was a Government agency, or organization, Offerors shall include the office symbol and program name this work sample supports.

Period of Performance: Offerors shall include the period of performance if the contract/order including all options. Offerors shall list the period of performance in the following format (MM/YYYY – MM/YYYY or MM/YYYY – Present):

Work Sample Value: Offerors shall enter the final or most recent total contract/order value of the work sample. The total value shall include the value of all options.

Was this Work Sample Performed as the Prime Contractor? The Offeror shall select ‘Yes’ if the Contractor listed under Contractor Name was the Prime under the work sample.

Work Sample Identifier: Work samples shall be numbered WS1-WS62.

PART II: WORK SAMPLE INFORMATION/POINTS OF CONTACT

Contracting Officer: Offerors shall provide the contact information for either the current Contracting Officer working the contract or the most recent Contracting Officer if the contract has ended. If there is no available Contracting Officer then leave this section blank.

Contracting Officer’s Representative (COR) or Relevant Customer Point of Contact: Offerors shall provide the contact information for the Primary (or Alternate if Primary is not available) COR. If a COR is not available, or if the work sample is not for a Government contract, Offerors shall provide a relevant customer point of contact that would be able to assist in validation of the work sample.

Prime Company Point of Contact. If the Offeror was a sub-contractor they shall provide the contract information for the Prime Contractor. If the Offeror was the Prime, then leave this section blank.

PART III: WORK SAMPLE DESCRIPTION (500 Character Limit) Offerors shall provide a brief description of the work sample.

PART IV: DEVIATION EXPLANATION

Offerors shall provide a brief explanation for any deviation to PPI Sheet instructions IAW L.8.7.2.

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