S02_RFP Specialized Experience Form.pdf
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- Solicitation number
- 36C24823R0189
About this file
This document is a specialized experience form for federal contractors to submit details of relevant past project experience. It requests information on up to three projects including the contractor name, DUNS number, phone number and point of contact, as well as the contract or task order number and award date. Bidders must indicate if they served as the prime contractor, subcontractor, joint venture or other role on each project and the percentage of work their company performed. If they were a subcontractor, they must provide the name of the prime contractor.
The related federal contract opportunity is a solicitation from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8 to install new x-ray equipment in room 2A168 at project number 36C24823R0189. No other details are provided on requirements, response dates, pricing or other terms.
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SPECIALIZED EXPERIENCE FORM
SPECIALIZED EXPERIENCE INFORMATION SHEET
PROJECT NO, I ) Page 1 Mvst hove Cl total of THREE (3) orolects, more than 3 will nor be evaluated; fes.s them 3 may result In o lower rotino.
a. Contractor Information of awarded contract lfflm Name, Addu:u, DUNS NIJITlbf:1 and Co-- uxlt:, Phont: nvro.be1, POC Norm:, POC ~mo.it Com--- ·emaJJ)
b. Contract and/or Task Order Number and Award Date (mm/dd/yyyyJ
C. Project Title/Name and Location
d. Work Performed as: Prime Contractor, Subcontractor, Joint Venture, Other {explain)
•• Percent (%} of project work performed by your company
f. if you work as subcontractor, who was the prime?
f F}(m N<ime, Aodress. OUNS Nvmber OflrJ Cog,e Cede; l'tlct1e 11vmoe1, POC Nome, POC em().((. compoi,y emoJIJ
g. Government Agency/ Company which awarded contract to offerer, and Contact Information, such Contracting Officer/Procurement Official/Point of Contract (Name, Title, Email, Phone Number).
EXPERIENCE INFORMATION SHEET
PROJECT NO. ( I Pue z
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 petformed is relevant to the effort required by the solicitation? Use continuation sheet for additional information, if necessary
EXPERIENCE INFORMATION SHEET
PROJECT NO. ) I Page 3
i. Describe any d ifficulties and/or obstacles encountered during performance; steps taken toward resolut ion j, Oe$Cribe 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 complet ion date, if not completed, projected completion date (mm/dd/yyyy)
I. Actual Comoletion Date (mm/dd/vvvy), and if not completed, whv?
Actual ComplettOn Oate:
If not completed, Why?
m. Project Is SO% or more complete? YES ( I No I ). If .. No» explain percentage of completion, if not 50% completed for any reason, rating may be lower.
n. The Offerers shall indicate if any of the contracts listed were terminated and the type and reasons for the termination.
0 , Original Contract Price (Award Amount), Final Contract Price (to ind ude all modifications, if applicable), Explain Differences.
Original Con tract Price: Final Contract Price:
Explain Differences:
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