S02 - Attachment 2 - Specialized Experience Form (3 Pages).pdf
PDF 134 KB Posted
- Attached to
- Reconfigure Lake Nona Dental Lab
- Solicitation number
- 36C24822R0084
About this file
This document contains a template for specialized experience forms and information on a federal contract opportunity for dental lab reconfiguration services. The specialized experience form template requests information on three past projects including contractor details, contract numbers, titles, locations, prime/subcontractor roles, completion dates, descriptions of scope and relevance to the opportunity, difficulties encountered, and pricing details.
The federal contract opportunity is to provide all design-build services to reconfigure the dental lab at Lake Nona VA, including demolishing and replacing cabinetry and workstations, installing stainless steel work areas, building a new wall, adding electrical outlets and data drops, installing a self-contained dust collector, laying seamless flooring and acoustic ceiling tiles, painting an exhaust hood, and ensuring compliance with VA planning criteria for dental imaging. Interested parties must be a state-licensed general contractor, with proposals due on an unspecified date. The work is to be performed for the VA Veterans Health Administration VISN 8.
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Other files
| File | Type | Posted |
|---|---|---|
| S02 - Attachment 3 - Drawings 675-22-102 Reconfigure Lake Nona Dental Lab Sheet.pdf | ||
| S02 - SOLICITATION FOR 36C24822R0084 - FINAL1.docx | DOCX document | |
| S02 - Attachment 4 - Price Matrix.xlsx | XLSX spreadsheet | |
| S02 - Attachment 1 - Wage Determination (1).pdf | ||
| S02 - Attachment 5 - EMR.docx | DOCX document | |
| S02 - Attachment 6 - Past Performance Questionnaire 36C24822R0084.pdf |
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Text version
SPECIALIZED EXPERIENCE FORM
SPECIALIZED EXPERIENCE INFORMATION SHEET
PROJECT NO. [ ] Page 1 Must have a total of THREE (3) projects, more than 3 will not be evaluated; less than 3 may result in a lower rating.
a. Contractor Information of awarded contract (Firm Name, Address, DUNS Number and Cage Code, Phone number, POC Name, POC email, Company email)
b. Contract and/or Task Order Number and Award Date (mm/dd/yyyy)
c. Project Title/Name and Location
d. Work Performed as: Prime Contractor, Subcontractor, Joint Venture, Other (explain)
e. Percent (%) of project work performed by your company
f. if you work as subcontractor, who was the prime?
(Firm Name, Address, DUNS Number and Cage Code, Phone number, POC Name, POC email, Company email)
g. Government Agency/Company which awarded contract to offeror, and Contact Information, such Contracting Officer/Procurement Official/Point of Contract (Name, Title, Email, Phone Number).
EXPERIENCE INFORMATION SHEET
PROJECT NO. [ ] Page 2
h. Description of project’s scope of work and the offeror’s specific roles and responsibilities in the project:
Describe work performed in sufficient detail to permit evaluation of project relevancy to this procurement. Detail how work performed is relevant to the effort required by the solicitation? Use continuation sheet for additional information, if necessary
EXPERIENCE INFORMATION SHEET
PROJECT NO. [ ] Page 3
i. Describe any difficulties and/or obstacles encountered during performance; steps taken toward resolution
j. Describe unforeseen conditions and how each were resolved
k. Performance Period, including contract start date (mm/dd/yyyy), and original completion date, if not completed, projected date (mm/dd/yyyy) contract start date:
original completion date, if not completed, projected completion date (mm/dd/yyyy)
l. Actual Completion Date (mm/dd/yyyy), and if not completed, why?
Actual Completion Date:
If not completed, Why?
m. Project is 50% or more complete? YES [ ] No [ ]. If “No” explain percentage of completion, if not 50% completed for any reason, rating may be lower.
n. The Offerors shall indicate if any of the contracts listed were terminated and the type and reasons for the termination.
o. Original Contract Price (Award Amount), Final Contract Price (to include all modifications, if applicable), Explain Differences.
Original Contract Price: Final Contract Price:
Explain Differences:
File details come from the government source that posted it. Updated .