J.P-8 MAS CTA Experience Template - PolarisHUBZone.docx
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- Polaris GWAC HubZone Pool
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- 47QTCB22R0006
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Polaris GWAC Program Attachment J.P-8
ATTACHMENT J.P-8
MULTIPLE AWARD SCHEDULE CONTRACTOR TEAMING ARRANGEMENT (MAS CTA) EXPERIENCE TEMPLATE
In accordance with Section L.5.1.3.4, an Offeror (to include members of a joint venture and proposed subcontractors) may use experience performed as a member of a Multiple Award Schedule Contractor Teaming Arrangement (MAS CTA). In these situations, the Offeror must submit this completed template identifying the work performed as part of the MAS CTA for the order. This template may not be used for purposes other than experience claimed in accordance with Section L.5.1.3.4. Additionally, this process is not required if individual award forms and FPDS-NG Reports were issued to each member of the MAS CTA.
CTA Member: Parts I, II and IV must be completed by the CTA Member.
After completing Parts I, II and IV, if verification of the contract/order is not provided by FPDS in accordance with L.5.2.2.1.1(1), the CTA Member must send this form to the cognizant Contracting Officer, Contracting Officer’s Representative, or other Government employee for verification in accordance with L.5.2.2.1.1(2) and/or L.5.2.3.1.1. The Contracting Officer, Contracting Officer’s Representative, or other Government employee with cognizance over the submitted project must provide this verification within Part III of this form.
Additionally, to verify the work performed as a member of the MAS CTA, Part V must be signed by a member of the MAS CTA (other than the member identified in Part I) or the Contracting Officer, Contracting Officer’s Representative, or other Government employee with cognizance over the submitted project.
After receiving the completed form, it must be submitted with the claimed Relevant Experience Project within the proposal.
Certifying CTA Member: You are receiving this form because the CTA Member (cited in Part I) claims that it performed the project identified in Part IV as a member of your CTA and is using the project as relevant experience for its Polaris proposal.
By signing this form in Part V you are verifying the CTA Member performed the work detailed in Part IV while a member of the CTA.
Customer: You are receiving this form because the MAS CTA Member (cited in Part I) claims that it performed as a member of a MAS CTA and is using the project as relevant experience for its Polaris GWAC proposal.
By signing this form in Part III, you are verifying the CTA performed the work as detailed in Part II. By signing this form in Part V, you are verifying the CTA Member performed the work detailed in Part IV while a member of the CTA.
PART I: MAS CTA MEMBER INFORMATION
| MAS CTA MEMBER NAME: |
| Click or tap here to enter text. |
PART II: MAS CTA ORDER INFORMATION
| CONTRACT NUMBER: |
| Click or tap here to enter text. |
| ORDER NUMBER: |
| 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. |
| TOTAL ORDER DOLLAR VALUE: |
| Click or tap here to enter text. |
| NAICS: |
| Click or tap here to enter text. |
| COST REIMBURSEMENT: (Y/N) |
| Choose an item. |
| OCONUS: (Y/N) |
| Choose an item. |
| EMERGING TECHNOLOGY: (Y/N. IF Y, IDENTIFY EMERGING TECHNOLOGY PROVIDED) |
| Click or tap here to enter text. |
| CYBERSECURITY SERVICES: (Y/N) |
| Choose an item. |
PART III: CUSTOMER CERTIFICATION
(IF APPLICABLE PER SECTION L.5.1.3.4, L.5.2.2.1.1, AND/OR L.5.2.3.1.1)
I certify that the MAS CTA performed the project as detailed above in Part II.
| NAME: |
| Click or tap here to enter text. |
| TITLE: |
| Click or tap here to enter text. |
| AGENCY: |
| Click or tap here to enter text. |
| EMAIL: |
| Click or tap here to enter text. |
| PHONE NUMBER: |
| Click or tap here to enter text. |
| SIGNATURE: |
| DATE: |
| Click or tap here to enter text. |
PART IV: PROJECT INFORMATION (WORK PERFORMED BY MAS CTA MEMBER IDENTIFIED IN PART I)
| TOTAL DOLLAR VALUE OF WORK PERFORMED BY MEMBER: |
| Click or tap here to enter text. |
| NAICS: |
| Click or tap here to enter text. |
| COST REIMBURSEMENT: (Y/N) |
| Choose an item. |
| OCONUS: (Y/N) |
| Choose an item. |
| EMERGING TECHNOLOGY: (Y/N. IF Y, IDENTIFY EMERGING TECHNOLOGY PROVIDED) |
| Click or tap here to enter text. |
| CYBERSECURITY SERVICES: (Y/N) |
| Choose an item. |
PART V: CERTIFICATION
I certify that the MAS CTA member identified in Part I performed the project as detailed in Part IV.
| NAME: |
| Click or tap here to enter text. |
| TITLE: |
| Click or tap here to enter text. |
| AGENCY OR COMPANY NAME: |
| Click or tap here to enter text. |
| EMAIL: |
| Click or tap here to enter text. |
| PHONE NUMBER: |
| Click or tap here to enter text. |
| SIGNATURE: |
| DATE: |
| Click or tap here to enter text. |
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