16R0106_A005_Attachment_11.pdf

RELEVANT EXPERIENCE QUESTIONNAIRE

PART I - EXPERIENCE RELEVANT to DiPSS CONTRACT

A. CONTRACT INFORMATION

1. RFP TITLE

Diplomatic Platform Support Services (DiPSS)

2.SOLICITATION OR PROJECT NUMBER

SAQMMA16R0106

B. OFFEROR’S POINT OF CONTACT

3. NAME AND TITLE

4. NAME OF FIRM

5. TELEPHONE NUMBER

6. E-MAIL ADDRESS

C. PROPOSED TEAM MEMBERS

(Complete this section for the prime contractor and all key subcontractors.)

(Check)

7. FIRM NAME 8. ADDRESS 9. ROLE IN THIS CONTRACT

P R

IM

E

J- V

P

A R

T N

E

S U

B C

O N

T

R A

C T

O a

CHECK IF BRANCH OFFICE

b

CHECK IF BRANCH OFFICE

c

CHECK IF BRANCH OFFICE

d

CHECK IF BRANCH OFFICE

e

CHECK IF BRANCH OFFICE

f

CHECK IF BRANCH OFFICE

D. ORGANIZATIONAL CHART OF PROPOSED TEAM (ATTACHED)

E. RESUMES OF KEY PERSONNEL PROPOSED FOR DiPSS CONTRACT (Complete one questionnaire for each key person.)

10. NAME

11. ROLE IN DiPSS CONTRACT

12. YEARS EXPERIENCE

12a. TOTAL

12b. WITH CURRENT FIRM

13. FIRM NAME AND LOCATION (City, State or Province and Country)

14. EDUCATION (DEGREE AND SPECIALIZATION)

15. CURRENT SECURITY CLEARANCE LEVEL AND ISSUING AGENCY

16. OTHER PROFESSIONAL QUALIFICATIONS (Publications, Organizations, Training, Awards, etc.)

17. RELEVANT PROJECTS

a

TITLE AND LOCATION (City ,State or Province and Country)

YEAR COMPLETED

SERVICES CONSTRUCTION (If Applicable)

BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE Check if project performed with current firm b

BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE Check if project performed with current firm c

BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE Check if project performed with current firm d

BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE Check if project performed with current firm e

BRIEF DESCRIPTION (Brief scope, size, cost, etc.) AND SPECIFIC ROLE Check if project performed with current firm

F. PROJECTS WHICH BEST ILLUSTRATE PROPOSED TEAM'S

RELEVANT EXPERIENCE FOR DiPSS CONTRACT

Present as many projects as requested by the agency, or 10 projects, if not specified.

Complete one questionnaire for each project.

18. PROJECT KEY NUMBER

19. PROJECT TITLE AND LOCATION (City, State or Province and Country)

20. YEAR COMPLETED

SERVICES

CONSTRUCTION (If applicable)

21. CLIENT'S INFORMATION

21a. CLIENT

21b POINT OF CONTACT

21c. POINT OF CONTACT TELEPHONE NUMBER AND

EMAIL

22. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO DiPSS CONTRACT (Include scope, size, and cost)

23. PROPOSED TEAM MEMBERS INVOLVED WITH THIS PROJECT

a.

FIRM NAME

FIRM LOCATION (City, State or Province and Country)

ROLE

b.

c.

d.

e.

f.

G. KEY PERSONNEL PARTICIPATION ON PROJECTS ILLUSTRATING RELEVANT EXPERIENCE

24. NAMES OF KEY

PERSONNEL

25. ROLE IN THIS

CONTRACT

26. PROJECTS ILLUSTRATING RELEVANT EXPERIENCE

(Fill in "Projects Key Number" section below before completing table. Place "X" under project key number for participation in same or similar role.)

1 2 3 4 5 6 7 8 9 10

27. PROJECTS KEY FOR RELEVANT EXPERIENCE FOR DiPSS CONTRACT

NO. PROJECT TITLE NO. PROJECT TITLE

H. ADDITIONAL INFORMATION ILLUSTRATING RELEVANT EXPERIENCE FOR DiPSS CONTRACT

28. PROVIDE ANY ADDITIONAL INFORMATION REQUESTED BY THE AGENCY. ATTACH ADDITIONAL SHEETS AS NEEDED.

I. AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts.

29. SIGNATURE

30. DATE

31. NAME AND TITLE

OFFEROR’S RELEVANT EXPERIENCE PROFILE 1. SOLICITATION NUMBER

SAQMMA16R0106

PART II – GENERAL INFORMATION

(If a firm has branch offices, complete questionnaire for each branch office seeking work.)

2a. FIRM (OR BRANCH OFFICE) NAME

3. YEAR ESTABLISHED

4. DUNS NUMBER

2b. STREET

5. OWNERSHIP

5a. TYPE

2c. CITY

2d. STATE

2e. ZIP CODE

5b. SMALL BUSINESS STATUS

6a. POINT OF CONTACT NAME AND TITLE

7. NAME OF FIRM (If a branch office)

6b. TELEPHONE NUMBER

6c. E-MAIL ADDRESS

8a. FORMER FIRM NAME(S) (If any) 8b. YR ESTABLISHED 8c. DUNS NUMBER

9. EMPLOYEES BY RELEVANT DISCIPLINE

10. PROFILE OF FIRM'S RELEVANT EXPERIENCE AND ANNUAL AVERAGE

REVENUE FOR LAST 5 YEARS

9a. Function

Code 9b. Discipline 9c. Number of Employees 10a.

Profile Code

10b. Experience 10c. Revenue Index Number (see below)

FIRM BRANCH

Other Employees Total

11. ANNUAL AVERAGE SERVICES REVENUES OF FIRM

FOR LAST 3 YEARS

(Insert revenue index number shown at right)

PROFESSIONAL SERVICES REVENUE INDEX NUMBER

1. Less than $100,000

2. $100,00 to less than $250,000

3. $250,000 to less than $500,000

4. $500,000 to less than $1 million

5. $1 million to less than $2 million

6. $2 million to less than $5 million

7. $5 million to less than $10 million

8. $10 million to less than $25 million

9. $25 million to less than $50 million

10. $50 million or greater

11a. Federal Work 11b. Non-Federal Work 11c. Total Work

12. AUTHORIZED REPRESENTATIVE

The foregoing is a statement of facts.

12a. SIGNATURE

12b. DATE

12c. NAME AND TITLE

RELEVANT EXPERIENCE QUESTIONNAIRE PREPARATION INSTRUCTIONS

GENERAL INSTRUCTIONS

Part I presents relevant experience for the DiPSS contract.

Part II presents the relevant experience of a firm or a specific branch office of a firm.

Prepare a separate Part II for each firm that will be part of the team proposed for the DiPSS contract and submitted with Part I. If a firm has branch offices, submit a separate Part II for each branch office that has a key role on the team.

DEFINITIONS

Branch Office: A geographically distinct place of business or subsidiary office of a firm that has a key role on the team.

Discipline: Primary technical capabilities of key personnel, as evidenced by academic degree, professional registration, certification, and/or extensive experience.

Key Personnel: Individuals who will have major contract responsibilities and/or provide unusual or unique expertise.

SPECIFIC INSTRUCTIONS

Part I ‐ Contract‐Specific Experience

Section B. Offeror’s Point of Contact.

Blocks 3‐6.

Name, Title, Name of Firm, Telephone Number, and E-mail Address. Provide information for a representative of the prime contractor or joint venture that the Department of State can contact for additional information.

Section C. Proposed Team.

Blocks 7‐9.

Firm Name, Address, and Role in This Contract. Provide the contractual relationship, name, full mailing address, and a brief description of the role of each firm that will be involved in performance of the DiPSS contract. List the prime contractor or joint venture partners first.

If a firm has branch offices, indicate each individual branch office that will have a key role on the team. The named subcontractors and outside associates or consultants must be used, and any change must be approved by the contracting officer. Attach an additional sheet in the same format as Section C if needed.

Section D. Organizational Chart of Proposed Team.

As an attachment after Section C, present an organizational chart of the proposed team showing the names and roles of all key personnel listed in Section E and the firm they are associated with as listed in Section C.

Section E. Resumes of Key Personnel Proposed for This Contract.

Complete this section for each key person who will participate in this contract. Group by firm, with personnel of the prime contractor or joint venture partner firms first. The following blocks must be completed for each resume:

10. Name.

Self-explanatory.

11. Role in DiPSS Contract.

Self-explanatory.

12. Years Experience.

Total years of relevant experience (block 12a), and years of relevant experience with current firm, but not necessarily the same branch office (block 12b).

13. Firm Name and Location.

Name, city and state of the firm where the person currently works. If the person does not currently work withone of the firms (or branch office of a firm, if appropriate) listed in Section C but is a contingent hire, provide a copy of a fully executed Letter of Intent. Letters of Intent must show the proposed salary for the contingent hire.

14. Education.

Provide information on the highest relevant academic degree(s) received. Indicate the area(s) of specialization for each degree.

15. Current Professional Registration.

Provide information on current relevant professional registration(s) in a State or possession of the United States, Puerto Rico, or the District of Columbia.

16. Other Professional Qualifications.

Provide information on any other professional qualifications relating to this contract, such as education, professional registration, publications, organizational memberships, certifications, training, awards, and foreign language capabilities.

17. Relevant Projects.

Provide information on up to five projects in which the person had a significant role that demonstrates the person's capability relevant to her/his proposed role in this contract. These projects do not necessarily have to be any of the projects presented in Section F for the project team if the person was not involved in any of those projects or the person worked on other projects that were more relevant than the team projects in Section F. Use the check box provided to indicate if the project was performed with any office of the current firm. If any of the projects are not complete, leave Year Completed blank and indicate the status in Brief Description and Specific Role.

Section F. Example Projects Which Best Illustrate Proposed Team's Qualifications for This Contract.

Select projects where multiple team members worked together, if possible, that demonstrate the team's capability to perform work similar to that required for this contract. Complete one Section F for each project. Present ten projects, unless otherwise specified by the agency. Complete the following blocks for each project:

18. Project Key Number.

Start with "1" for the first project and number consecutively.

19. Project Title and Location.

Title and location of project or contract. For an indefinite delivery contract, the location is the geographic scope of the contract as represented by the countries in which the offeror has performed work..

20. Year Completed.

Enter the year completed of the services projects, or the year completed of construction, if applicable. If any of the services projects or the construction projects are not complete, leave Year Completed blank and indicate the status in Brief Description of Project and Relevance to This Contract (block 22).

21a. Client.

Client or user, such as a government agency or installation, an institution, a corporation or private individual.

21b. Point of Contact Name.

Provide name of a person associated with the client or the organization which contracted for the services, who is very familiar with the project and the firm's (or firms') performance.

21c. Point of Contract Telephone Number.

Self-explanatory.

22. Brief Description of Project and Relevance to DiPSS Contract.

Indicate scope, size, cost, principal elements and special features of the project. Discuss the relevance of the project to the DiPSS contract. Enter any other information requested by the agency for each project.

23. Firms from Section C Involved with This Project.

Indicate which firms (or branch offices, if appropriate) on the project team were involved in the example project, and their roles. List in the same order as Section C.

Section G. Key Personnel Participation in Example Projects.

This matrix is intended to graphically depict which key personnel identified in Section E worked on the example projects listed in Section F. Complete the following blocks.

24. and 25. Names of Key Personnel and Role in the DiPSS Contract.

List the names of the key personnel and their proposed roles in the DiPSS contract in the same order as they appear in Section E.

26. Example Projects Listed in Section F.

In the column under each project key number (see block 27) and for each key person, place an "X" under the project key number for participation in the same or similar role.

27. Example Projects Key.

List the key numbers and titles of the projects in the same order as they appear in Section F.

Section H. Additional Information.

Block 28.

Use this section to provide additional information specifically requested by the agency.

Section I. Authorized Representative.

Blocks 31. and 32. Signature of Authorized Representative and Date.

An authorized representative of a joint venture or the prime contractor must sign and date the completed form. Signing attests that the information provided is current and factual, and that all firms on the proposed team agree to work on the project. Joint ventures must provide a statement of participation by a principal of each member of the joint venture.

Block 33. Name and Title.

Self-explanatory.

Part II ‐ General Experience See the "General Instructions" on page 1 for firms with branch offices. Prepare Part II for the specific branch office seeking work if the firm has branch offices.

Blocks 2a‐2e. Firm (or Branch Office) Name and Address.

Self-explanatory.

Block 3. Year Established.

Enter the year the firm (or branch office, if appropriate) was established under the current name.

Block 4. DUNS Number.

Insert the Data Universal Numbering System number issued by Dun and Bradstreet Information Services. Firms must have a DUNS number.

Block 5. Ownership.

Block 5a. Type.

Enter the type of ownership or legal structure of the firm (sole proprietor, partnership, corporation, joint venture, etc.).

Block 5b. Small Business Status.

Refer to the North American Industry Classification System (NAICS) code in the public announcement, and indicate if the firm is a small business according to the current size standard for that NAICS code. The small business categories and the internet website for the NAICS codes appear in FAR Part 19. Contact the Department of State for any questions. Contact your local U.S. Small Business Administration office for any questions regarding Business Status.

Blocks 6a‐6c. Point of Contact.

Provide this information for a representative of the firm that the agency can contact for additional information. The representative must be empowered to speak on contractual and policy matters.

Block 7. Name of Firm.

Enter the name of the firm if Part II is prepared for a branch office.

Block 8a‐8c. Former Firm Names.

Indicate any other previous names for the firm (or branch office) during the last six years. Insert the year that this corporate name change was effective and the associated DUNS Number.

Block 9. Employees by Discipline.

Use the relevant disciplines and associated function codes shown at the end of these instructions and list in the same numerical order.

After the listed disciplines, write in any additional disciplines and leave the function code blank. List no more than 20 disciplines. Group remaining employees under "Other Employees" in column b. Each person can be counted only once according to his/her primary function. If Part II is prepared for a firm (including all branch offices), enter the number of employees by disciplines in column titled “FIRM”. If Part II is prepared for a branch office, enter the number of employees by discipline in column titled “BRANCH” and for the firm in column titled “FIRM”.

Block 10. Profile of Firm's Experience and Annual Average Revenue for Last 5 Years.

Complete this block for the firm or branch office for which this Part II is prepared. Enter the experience categories which most accurately reflect the firm's technical capabilities and project experience. Use the relevant experience categories and associated profile codes shown at the end of these instructions, and list in the same numerical order. After the listed experience categories, write in any unlisted relevant project experience categories and leave the profile codes blank. For each type of experience, enter the appropriate revenue index number to reflect the professional services revenues received annually (averaged over the last 5 years) by the firm or branch office for performing that type of work. A particular project may be identified with one experience category or it may be broken into components, as best reflects the capabilities and types of work performed by the firm. However, do not double count the revenues received on a particular project.

Block 11. Annual Average Services Revenues of Firm for Last 3 Years.

Complete this block for the firm or branch office for which this Part II is prepared. Enter the appropriate revenue index numbers to reflect the services revenues received annually (averaged over the last 3 years) by the firm or branch office. Indicate Federal work (performed directly for the Federal Government, either as the prime contractor or subcontractor), non-Federal work (all other domestic and foreign work, including Federally-assisted projects), and the total. If the firm has been in existence for less than 3 years, see the definition for "Annual Receipts" under FAR 19.101.

Block 12. Authorized Representative.

An authorized representative of the firm or branch office must sign and date the completed form. Signing attests that the information provided is current and factual. Provide the name and title of the authorized representative who signed the form.

LIST OF DISCIPLINES AND FUNCTION CODES

CODE DESCRIPTION

A001 Accountable Property Officer A002 Accountant A003 Air Operations Manager B001 Bank Tellers C001 Cafeteria Staff C002 Cashier C003 Chief Engineer C004 Commissary Staff C005 Construction Engineer C006 Contract Administrator C007 Contract Manager C008 Courier C009 Courier Travel System (CTS) Administrator C010 Customs Manager D001 Despatch Agency Administrator D002 Dispatcher D003 Disposal Clerk D004 Driver D005 DS/ST CMMS-ILMS User E001 Electrical Supervisor E002 Expeditor E003 Expendable Stock Clerk F001 Facilities Manager F002 Fire Chief F003 Food Operations Manager F004 Fuel Clerk G001 Gardeners G002 General Services Officer H001 Housing Service Manager H002 Human Resource Manager H003 HVAC Supervisor I001 Information Management Officer I002 Inventory Control I003 IT Manager J001 Janitors L001 Landscaping/Groundskeeper Manager L002 Loanable Property Clerk L003 Logistics Manager M001 Mail & Pouch M002 Mailroom Clerk M003 Maintenance Clerk M004 Management Officer M005 Motor Pool Supervisor O001 Operations Manager

LIST OF DISCIPLINES AND FUNCTION CODES

CODE DESCRIPTION

O002 Order Fulfillment P001 Picker P002 Plumbing/Mechanical Supervisor P003 Post Shipping Staff P004 Procurement Manager P005 Program Manager P006 Project Manager P007 Property Clerk P008 Purchase Cardholder Q001 Quality Assurance Manager R001 Receiver R002 Receiving Clerk S001 Safety Manager S002 Security Manager S003 Shipping/Receiving Manager S004 Site Operations Manager T001 Task Order Manager T002 Task Order Site Manager T003 Telephone & Radio Support T004 Traffic Manager T005 Transportation Service Manager T006 Travel Coordinator V001 Voucher Examiner W001 Warehouse Supervisor

LIST OF EXPERIENCE CATEGORIES AND PROFILE CODES

Code Experience Category AA01 Accounting Services

AA02 Administrative Management and General Management Consulting Services

AA03 Administrative Services, Office

AA04 Air Traffic Control

AA05 Airport Operations

AA06 Architectural Services

BB01 Barber Shops

BB02 Beauty Salons

BB03 Building and Property Specialty Trade Services

BB04 Building Inspection Services

BB05 Bus and Other Motor Vehicle Transit Systems

CC01 Cafeterias, Grill Buffets, and Buffets

CC02 Car Washes

CC03 Carpet and Upholstery Cleaning Services

CC04 Caterers

CC05 Chartered Freight Air Transportation

CC06 Chartered Passenger Air Transportation

CC07 Construction Management

CC08 Construction Surveying

CC09 Construction Testing & Inspection

CC10 Cost Estimating; Cost Engineering and Analysis;

CC11 Couriers and Express Delivery Services

DD01 Dry-cleaning and Laundry Services

EE01 Electrical Studies and Design

EE02 Elevators; Escalators; People-Movers

EE03 Embassies and Chanceries

EE04 Energy Audits

EE05 Energy Conservation; New Energy Sources

EE06 Energy Infrastructure

EE07 Energy Management

EE08 Engineering Services

EE09 Environmental Audits

EE10 Environmental Impact Studies, Assessments or Statements

EE11 Environmental Remediation

EE12 Environmental Testing and Analysis

EE13 Exterminating and Pest Control Services

FF01 Facilities Management

FF02 Facilities Support Services (NAICS 561210)

FF03 Fire Protection

FF04 Food Service Contractors

FF05 Freight Transportation Arrangement

FF06 Freight Trucking, Local

FF07 Freight Trucking, Long‑Distance, Less Than Truckload FF08 Freight Trucking, Long‑Distance, Truckload II01 Interior Design Services

JJ01 Janitorial Services

LL01 Landscaping Services

LIST OF EXPERIENCE CATEGORIES AND PROFILE CODES

Code Experience Category LL02 Launderers, Industrial

LL03 Linen Supply

LL04 Locksmiths

MM01 Materials Recovery Facilities

MM02 Motor Vehicle Towing

OO01 Other Services to Buildings and Dwellings (NAICS 561790)

PP01 Packing and Crating

PP02 Parametric Costing; Forecasting

PP03 Postal Service

RR01 Remediation Services, (NAICS 562910)

RR02 Repair and Maintenance, Appliance

RR03 Repair and Maintenance, Automotive (NAICS 811198)

RR04 Repair and Maintenance, Commercial and Industrial Machinery and Equipment

RR05 Repair and Maintenance, Communication Equipment

RR06 Repair and Maintenance, Computer and Office Machine

RR07 Repair and Maintenance, Consumer Electronics

RR08 Repair and Maintenance, Electronic and Precision Equipment

RR09 Repair and Maintenance, Home and Garden Equipment

RR10 Repair and Maintenance, Personal and Household Goods

RR11 Repair, Automotive, General (NAICS 811111)

RR12 Reupholster and Furniture Repair

SS01 Septic Tank and Related Services

SS03 Solid Waste Combustors and Incinerators

SS04 Solid Waste Landfill

SS05 Support Activities for Air Transportation

SS06 Support Activities for Transportation

TT01 Travel Arrangement and Reservation Services

WW01 Warehousing and Storage

WW02 Warehousing and Storage, Other (NAICS 493190)

WW03 Warehousing and Storage, Refrigerated

WW04 Waste Collection, Hazardous

WW05 Waste Collection, Nonhazardous Solid

WW06 Waste Collection, Other (NAICS 562119)

WW07 Waste Treatment and Disposal, Hazardous

WW08 Waste Treatment and Disposal, Nonhazardous