I. B-08 GPS Appendix A Work Sample MS Word (AMD 0004) - 12FEB2025.docx

Section L Appendix A 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 in USD

Is the Work Sample as the Prime Contractor

Subcontract Number (if Applicable)

Work Sample Identifier:

Primary Scope of work

Part II: Work Sample Information/Points of Contact

1. Contracting Officer

Name:

Phone:

Email:

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

Name:

Phone:

Email:

3. Prime Company Point of Contact

Name:

Title:

Company:

Phone:

Email:

Part III: Project Description

Instructions to Appendix A to Section L - Work Sample Cover Sheet Offerors shall follow the instructions below when filling out Appendix A 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.

Is the Work Sample as the Prime Contractor: The Offeror shall write 'Yes' if the Contractor listed under Contractor Name was the Prime under the work sample.

Work Sample Identifier: Works samples shall be numbered WS1-WS40. Insert the applicable work sample number.

Primary Scope of Work: Enter one or more of the following PTE Sections.

Part II: Contracting Officer’s Representative or Relevant Customer Point 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: Project Description (750 Character Limit) Offerors shall provide a brief description of the work sample. The information provided will not be evaluated by the Past Experience Evaluation Team. If the Offeror uses a subsidiary or legal entity work sample as a prime work sample, the Offeror may use this section to describe the relationship.