Attachment_11.docx

LIST OF EXPERIENCE CATEGORIES AND PROFILE CODES

RELEVANT EXPERIENCE QUESTIONNAIRE

PART I - EXPERIENCE RELEVANT 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.)

PARTNER

SUBCON-TRACTOR

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

RELEVANT EXPERIENCE QUESTIONNAIRE

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 PROFESSIONAL REGISTRATION (State or Province, Country, and Discipline)

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

17. RELEVANT PROJECTS

YEAR COMPLETED

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

YEAR COMPLETED

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

YEAR COMPLETED

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

YEAR COMPLETED

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

YEAR COMPLETED

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

RELEVANT EXPERIENCE QUESTIONNAIRE

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

FIRM LOCATION (City, State or Province and Country)

ROLE

FIRM LOCATION (City, State or Province and Country)

ROLE

FIRM LOCATION (City, State or Province and Country)

ROLE

FIRM LOCATION (City, State or Province and Country)

ROLE

FIRM LOCATION (City, State or Province and Country)

ROLE

FIRM LOCATION (City, State or Province and Country)

ROLE

RELEVANT EXPERIENCE QUESTIONNAIRE

G. KEY PERSONNEL PARTICIPATION ON 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.)

27. PROJECTS KEY FOR RELEVANT EXPERIENCE FOR DiPSS CONTRACT

RELEVANT EXPERIENCE QUESTIONNAIRE

H. ADDITIONAL INFORMATION ILLUSTRATING RELEVANT EXPERIENCE FOR THIS 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

RELEVANT EXPERIENCE QUESTIONNAIRE

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

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

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, which must correspond with one of the firms (or branch office of a firm, if appropriate) listed in Section C.

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.

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.

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.

RELEVANT EXPERIENCE QUESTIONNAIRE PREPARATION INSTRUCTIONS

LIST OF DISCIPLINES AND FUNCTION CODES

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