Past_Project_Form_-_Attachment_IV.docx

DOCX document 153 KB Posted Mar 17, 2015

Attached to: Administrative Services for DHS/NPPD/FPS Region 3
Solicitation number: HSHQE3-15-R-00001
Issued by: Department of Homeland Security Office of Procurement Operations

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Attachment IV - Past Project Form (Word version)

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U.S. Department of Homeland Security Washington, DC 20528

ADMINISTRATIVE SUPPORT SERVICES FOR REGION 3 – PAST PROJECT FORM

ADMINISTRATIVE SUPPORT SERVICES FOR REGION 3

PAST PROJECT FORM

ATTACHMENT IV

1. Name of Contractor

1a. Solicitation Number (i.e. the solicitation your firm is responding to)

2. Complete Name of Government Agency, Commercial Firm, or Other Organization for Which Effort was Performed.

3. Complete Address of Entity Named in #2 Above.

3A. Complete Name, Phone Number and Email Information for a Point of Contact.

4. Contract Number or Other Reference

5. Date of Project Award

6. Total Project Price (to include all options)

7. Period of Performance (to include all options)

8. Clearance Required (If yes, specify level)

9a. Number of Productive Hours Per Annum

9b. Job Type(s) of Workers

10. Total Number of Locations

11. Total Number of Employees at Each Site

12a. Technical Point of Contact (name, title, address, telephone no., and email address)

12b. Contracting or Purchasing Point of Contact (name, title, address, telephone no., and email address)

13. Geographic Location of Work (Country, State or Province, County, City)

14. Description of Contract Work. In order to establish the relevance of your project to the instant requirement, please describe the scope, magnitude and complexity of this work, comparing and contrasting it to that required under this solicitation. Additionally, describe any unique or unusual requirements of the contract, and performance problems or issues encountered under the performance of the contract. Include discussion of any previous or ongoing Department of Labor investigations of your firm for Service Contract Act or other labor related violations. For problems/issues noted, describe the method of resolution and/or corrective actions taken. Use a continuation sheet, if necessary.

15. Did this contract require the submission of a subcontracting plan? If so, describe the efforts being made to meet the subcontracting goals contained within the approved plan to include the name(s) of subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s).

Instructions for Completing the Past Project Form

Item1	Insert Name of Offeror
Item 1a	Insert Solicitation Number
Item 2	Insert the complete name of the customer, including parent organization. Do not use acronyms.
Item 3	Insert the customer's complete address, including both post office box and street address, if applicable.
Item 4	Insert any contract number or other contract reference used by the customer.
Item 5	Insert the date on which the contract came into existence.
Item 6	Insert the price, as it appeared in the original contract inclusive of all option periods. If the contract included multiple, separately-priced items, add the individual item amounts and insert the total price.
Item 7	Insert the period of performance to include all option periods (if applicable).
Item 8	Annotate whether or not a clearance was required. If applicable, insert the type clearance, i.e. Top Secret, Secret)
Item 9a	Insert the number of productive hours under the contract on an annual basis.
Item 9b	List the types of jobs (e.g. clerical, data input, etc.) Indicate the distribution of hours between the types of work.
Item 10	Insert the number of locations where employees worked on this contract.
Item 11	Insert the number of employees at each site.
Item 12a	Insert the name, title, address, telephone number, and email address (if available) of the program or project manager, quality assurance representative, or other customer technical representative who is most familiar with the quality of your work under the contract.
Item 12b	Insert the name, title, address, telephone number, and email address (if available) of the contracting officer, purchasing agent, or other customer contracting or purchasing representative who is most familiar with your work under the contract.
Item 13	Insert the location(s) where the work was performed, including the country (if other than the United States) and the state or province, county (if applicable), and city.
Item 14	Describe the nature and scope of the work. The objective is to show how the work that you did or are doing is similar in nature and scope to the work that is to be performed under the contract contemplated by the request for proposal. Describe any unique or unusual requirements of the contract and any problems encountered during the performance of this contract work. Tell your side of the story of any conflicts with the customer concerning which they may make adverse remarks about your performance. Describe any actions that you have taken or plan to take to correct any shortcomings in your performance.
Item 15	Insert the name, address, telephone number, and email address (if available) of the subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s)

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File details come from the government source that posted it. Updated Nov 14, 2017.