J.P-6 Project Verification Form Polaris SDVOSB.docx
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- Solicitation number
- 47QTCB22R0007
- Issued by
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GSA Federal Acquisition Service
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Polaris GWAC Program Attachment J.P-6
ATTACHMENT J.P-6
PROJECT VERIFICATION FORM
This attachment may be used as the Project Verification Form when required by Section L.5.2.2.1.1(2), L.5.2.2.1.2 and/or L.5.2.3.1.1 for verification of submitted relevant experience.
Offeror: Parts I and II must be completed by the Offeror.
After completing Parts I and II, the Offeror must send this form to the cognizant Contracting Officer, Contracting Officer’s Representative, other Government employee or Corporate Officer/Official for verification in accordance with L.5.2.2.1.1(2), L.5.2.2.1.2 and/or L.5.2.3.1.1. The cognizant Contracting Officer, Contracting Officer’s Representative, other Government employee or Corporate Officer/Official must provide this verification within Part III of this form. After receiving the completed form, it must be submitted with the claimed Relevant Experience Project within the proposal.
Customer: You are receiving this form because the contractor (cited in Part I) is claiming the below project as relevant experience in response to the Polaris GWAC solicitation.
By signing this form in Part III, you are verifying the contractor performed the work as detailed in Part I.
PART I: PROJECT IDENTIFICATION
| CONTRACTOR NAME: |
| Click or tap here to enter text. |
| CONTRACT NUMBER: |
| Click or tap here to enter text. |
| ORDER NUMBER (if applicable): |
Click or tap here to enter text.
| PROJECT NAME: |
| Click or tap here to enter text. |
| FUNDING AGENCY ID OR CUSTOMER: |
| Click or tap here to enter text. |
| TOTAL PERIOD OF PERFORMANCE, INCLUDING OPTIONS: (MM/YYYY – MM/YYYY or MM/YYYY – Present) |
| Click or tap here to enter text. |
| PROJECT VALUE: |
| Click or tap here to enter text. |
| PROJECT NAICS: (The claimed NAICS must have been integral to the performance of the Project.) |
| Click or tap here to enter text. |
| COST REIMBURSEMENT: (Y/N) |
| Choose an item. |
| OCONUS: (Y/N) |
| Choose an item. |
| EMERGING TECHNOLOGY: (If claimed, identify the emerging technology provided) |
| Click or tap here to enter text. |
| CYBERSECURITY SERVICES: (Y/N) |
| Choose an item. |
PART II: PROJECT CONTACT INFORMATION
Contracting Officer (or Corporate Officer/Employee of the customer with cognizance over the submitted project for Non-Federal projects)
| NAME: |
| Click or tap here to enter text. |
| TITLE: |
| Click or tap here to enter text. |
| AGENCY OR CUSTOMER: |
| Click or tap here to enter text. |
| PHONE: |
| Click or tap here to enter text. |
| EMAIL: |
| Click or tap here to enter text. |
Contracting Officer’s Representative or Government employee (Complete only if COR or other Government employee providing signature verification in Part III)
| NAME: |
| Click or tap here to enter text. |
| TITLE: |
| Click or tap here to enter text. |
| AGENCY OR CUSTOMER: |
| Click or tap here to enter text. |
| PHONE: |
| Click or tap here to enter text. |
| EMAIL: |
| Click or tap here to enter text. |
PART III: PROJECT VERIFICATION
Signature below by a Contracting Officer, Contracting Officer’s Representative, other Government employee or Corporate Official for the ordering activity constitutes acceptance of the above project information to be accurate as ordered and received by the listed entity.
| NAME: |
| Click or tap here to enter text. |
SIGNATURE:
| DATE: |
| Click or tap here to enter text. |
File details come from the government source that posted it. Updated .