S02 ATTACHMENT D SPECIALIZED EXPERIENCE FROM.pdf

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Attached to
Bid/Build Renovate Spinal Cord Unit Federal contract opportunity
Solicitation number
36C24823R0107
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8

About this file

This document contains a specialized experience form and information on a related federal contract opportunity for renovating a spinal cord unit at the Miami VA Medical Center. The specialized experience form requests information on three past projects demonstrating relevant experience, including contractor details, contract numbers, project titles and locations, roles and responsibilities, descriptions of scope and relevance to the opportunity, performance periods and completion dates, difficulties encountered and resolutions, and pricing details. The related federal contract opportunity is a fixed-price construction services contract to renovate walls, floors, and ceilings across approximately 29,785 square feet of the spinal cord building. The scope includes renovating hallways, patient rooms, and staff areas but excludes telecom rooms and areas with ceramic tile or epoxy flooring. Contractors must provide all materials, tools, labor, personal protective equipment, and supervision to complete the project.

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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:

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