S02 - Attachment 5 - Specialized Experience Form (3 Pages).pdf
PDF 134 KB Posted
- Attached to
- Replace Lake Baldwin DOM Hot Water Heater Federal contract opportunity
- Solicitation number
- 36C24823R0131
About this file
This document contains a specialized experience form and information on a federal contract opportunity to replace the water heater system at the Lake Baldwin Domiciliary Building 520 for the Department of Veterans Affairs.
The specialized experience form requests information on three past projects including contractor details, contract numbers and award dates, project titles and locations, prime contractor or subcontractor role, percentage of work performed, description of scope of work and responsibilities, performance periods with start and completion dates, difficulties encountered and resolutions, unforeseen conditions and resolutions, and original and final contract prices with explanations for differences.
The federal contract opportunity involves assessing, designing, and building a replacement for the existing water heater system. The work includes general construction, alterations for civil, structural, plumbing, mechanical and electrical work. The solicitation number is 36C24823R0131 and the description is to replace the outdated unit to meet all applicable codes and regulations at the Lake Baldwin Domiciliary Building 520 for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8.
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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 .