Attachment_1_thru_4.pdf

SECTION J ‐ ATTACHMENTS / REFERENCES

ATTACHMENT 1

IDENTIFICATION OF PRINCIPAL GEOGRAPHIC CODE NUMBERS

ADS 310.3.1.1sets forth the official description of all geographic codes used by USAID in authorizing or implementing documents, to designate authorized source countries or areas for procurement of goods and services. The following are summaries of the principal codes:

Code 937: The United States, the recipient country, and developing countries other than advanced developing countries, but excluding any country that is a prohibited source*.

Code 110: The United States, the independent states of the former Soviet Union, or a developing country, but excluding any country that is a prohibited source*.

Code 935: Any area or country including the recipient country, but excluding any country that is a prohibited source.*

* The list of countries designated as prohibited sources is attached as Mandatory Reference 310mac, List of Prohibited Source Countries. Countries may be added to or removed from this list by the Administrator and upon receiving foreign policy guidance from the Department of State, as appropriate.

ATTACHMENT 2

OMB Control No. 0412-0520; Expiration Date: 02/28/2014

CONTRACTOR EMPLOYEE BIOGRAPHICAL DATA SHEET

1. Name (Last, First, Middle)

2. Contractor’s Name

3. Employee’s Address (include ZIP code)

4. Contract Number

5. Position Under Contract

6. Proposed Salary

7. Duration of Assignment

8. Telephone Number (include area code)

9. Place of Birth

10. Citizenship (If non-U.S. citizen, give visa status)

11. Names, Ages, and Relationship of Dependents to Accompany Individual to Country of Assignment

12. EDUCATION(include all college or university degrees) 13. LANGUAGE PROFICIENCY(see Instruction on Page 2)

NAME AND LOCATION OF INSTITUTION MAJOR DEGREE DATE LANGUAGE

Proficiency Speaking

Proficiency Reading

14. EMPLOYMENT HISTORY

1. Give last three (3) years. List salaries separate for each year. Continue on separate sheet of paper if required to list all employment related to duties of proposed assignment.

2. Salary definition – basic periodic payment for services rendered. Exclude bonuses, profit-sharing arrangements, commissions, consultant fees, extra or overtime work payments, overseas differential or quarters, cost of living or dependent education allowances.

POSITION TITLE

EMPLOYER’S NAME AND ADDRESS

POINT OF CONTACT &TELEPHONE #

Dates of Employment (M/D/Y) Annual Salary

From To Dollars

15. SPECIFIC CONSULTANT SERVICES (give last three (3) years)

SERVICES PERFORMED

EMPLOYER’S NAME AND ADDRESS

POINT OF CONTACT &TELEPHONE #

Dates of Employment (M/D/Y) Days at Rate

Daily Rate In Dollars From To

16. CERTIFICATION: To the best of my knowledge, the above facts as stated are true and correct.

Signature of Employee Date

17. CONTRACTOR'S CERTIFICATION(To be signed by responsible representative of Contractor)

Contractor certifies in submitting this form that it has taken reasonable steps (in accordance with sound business practices) to verify the information contained in this form. Contractor understands that USAID may rely on the accuracy of such information in negotiating and reimbursing personnel under this contract. The making of certifications that are false, fictitious, or fraudulent, or that are based on inadequately verified information, may result in appropriate remedial action by USAID, taking into consideration all of the pertinent facts and circumstances, ranging from refund claims to criminal prosecution.

Signature of Contractor’s Representative Date

ATTACHMENT 2 (continued)

BIOGRAPHICAL DATA SHEET INSTRUCTIONS

Indicate your language proficiency in block 13 using the following numeric Interagency Language Roundtable levels (Foreign Service Institute Levels). Also, the following provides brief descriptions of proficiency levels 2, 3, 4, and 5. “S” indicates speaking ability and “R” indicates reading ability. For more in-depth description of the levels refer to USAID Handbook 28 or superseding policy directive.

2. Limited working proficiency

S Able to satisfy routine special demands and limited work requirements.

R Sufficient comprehension to read simple, authentic written material in a form equivalent to usual printing or typescript on familiar subjects within familiar contexts.

3. General professional proficiency

S Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively in most formal and informal conversations on practical, social, and professional topics.

R Able to read within a normal range of speed and with almost complete comprehension of a variety of authentic prose material on unfamiliar subjects.

4. Advanced professional proficiency

S Able to use the language fluently and accurately on all levels normally pertinent to professional needs.

R Able to read fluently and accurately all styles and forms of the language pertinent to professional needs.

5. Functional native proficiency

S Speaking proficiency is functionally equivalent to that of a highly articulate well-educated native speaker and reflects the cultural standards of a country where the language is natively spoken.

R Reading proficiency is functionally equivalent to that of the well-educated native reader.

ATTACHMENT 3

ATTACHMENT 3 (continued)

ATTACHMENT 4

PAST PERFORMANCE INFORMATION

PERFORMANCE REPORT - SHORT FORM

PART I: Award Information (to be completed by Prime)

1. Name of Awarding Entity:

2. Award Number:

3. Award Type:

4. Award Value (TEC): (if sub-agreement, sub-agreement value)

5. Problems: (if problems encountered on this award, explain corrective action taken)

6. Contacts: (Name, Telephone Number and E-mail address) 6.a. Agreement Officer:

6.b. Contracting Officer Representative (COR):

6.c. Other:

7. Recipient:

8. Title/Brief Description of Product/Service Provided:

9. Information Provided in Response to RFP No. :

PART II: Performance Assessment (to be completed by Agency)

1. Quality of product or service, including consistency in meeting goals and targets, and cooperation and effectiveness of the Prime in fixing problems. Comment:

2. Cost control, including forecasting costs as well as accuracy in financial reporting. Comment:

3. Timeliness of performance, including adherence to contract schedules and other time-sensitive project conditions, and effectiveness of home and field office management to make prompt decisions and ensure efficient operation of tasks. Comment:

4. Customer satisfaction, including satisfactory business relationship to clients, initiation and management of several complex activities simultaneously, coordination among subcontractors and developing country partners, prompt and satisfactory correction of problems, and cooperative attitude in fixing problems. Comment:

5. Effectiveness of key personnel including: effectiveness and appropriateness of personnel for the job; and prompt and satisfactory changes in personnel when problems with clients where identified. Comment:

[Note: The actual dollar amount of the sub-agreement, if any, (awarded to the Prime) must be listed in Block 4 instead of the Total Estimated Cost (TEC) of the overall contract. In addition, a Prime may submit attachments to this past performance table if the spaces provided are inadequate; the evaluation factor(s) must be listed on any attachments.]