Attachment_0001_Experience_Reporting_Form.pdf
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- Solicitation number
- W912DY-17-R-0028
About this file
This document contains an experience reporting form and details of a related federal contract opportunity for Medical Facilities Support Services IIa. The experience reporting form requests information on previous projects to demonstrate experience with similar scope, and involves self-performed work, subcontracted work, dates, and performance ratings. The related federal contract opportunity is solicitation number W912DY-17-R-0028 from the Department of the Army Corps of Engineers Engineering Support Center Huntsville for Medical Facilities Support Services IIa. The opportunity was amended to remove key personnel requirements from the solicitation, letter of commitment, cost template, and questions and answers. Other requirements remain unchanged.
Experience Reporting Form
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ATTACHMENT 0001
EXPERIENCE REPORTING FORM
Tracking Number: Form No. of (e.g. 1 of 12)
Provide the following information to identify projects your company completed within the last five years that show experience with projects of similar type and scope. Use one form per project.
a. Does the experience claimed on this form derive from projects that were executed using native, in-house skills and resources? Yes No
b. If the experience claimed is from other sources (you answered “no” above), check the appropriate box below which most closely identifies the relationship:
Teaming Arrangement Partnership Sub-Contractor
c. Name of Offeror:
d. Contract Number, Title and Location of Project:
e. Contract Type and Pricing Arrangement:
f. Type of System Installed (e.g. UMCS, HVAC, ESS, FAS, and SCADA)
g. Reference (Client) Contact Information (includes POC name, address, phone, and email address):
h. Describe how the contract referenced is relevant to the immediate acquisition. If only portions of the contract are relevant, specify which portions of the contract are relevant to the immediate acquisition:
i. Describe your Role (Prime, Joint Venture, or Subcontractor, etc.):
j. Your Contract or Subcontract Amount: ($)
k. Detailed Description of Your Self-Performed Work (include percentage of total cost):
l. Describe any Work You Subcontracted to Others (include names, addresses, and values):
m. Dates Your contract: Began: Completed:
n. Your Performance Evaluation Rating, if known:
o. Were you ever issued a Cure or Show Cause Letter? yes
no. If “yes”, provide explanation:
p. Were you Terminated or Assessed Liquidated Damages? yes
no. If “yes”, provide explanation:
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