Attachment 3 - Experience Reporting Form.pdf

ATTACHMENT 3 EXPERIENCE REPORTING FORM

Tracking Number: Form No. of (e.g. 1 of 5)

Provide the following information to identify projects your company completed, or are within

50% of completion, within three (3) years from the initial issuance date of this Solicitation.

Projects should demonstrate the Offeror’s experience in abatement and demolition of facilities.

a. Project Title:

b. Name of Offeror:

c. Role of Offeror (Prime, Joint Venture Partner, Key Subcontractor, Subcontractor, etc.):

d. Contract Number:

e. Location of Project:

f. Contracting Agency/Office:

g. Contract Type and Pricing Arrangement:

h. Contract or Subcontract Amount (to include breakdown of costs by costs by modifications):

i. Contract Dates: Award: Completed:

j. Description of Work (e.g., facility reduction/demolition plans, ACM/ORM abatement/removal, facility demolition/removal, dismantling, site restoration):

k. Detailed Description of Self-Performed Work as the Prime (to include what trades & specialties directly provided and percentage of total cost):

l. Describe Work Subcontracted to Others as the Prime (to include names, addresses, and values):

m. Reference (Client) Contact Information (to include POC name, address, phone, and email address):

n. 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:

o. Contract Performance Evaluation Rating, if known:

p. Describe past performance in terms of schedule, budget, quality control, safety, problems (if any) and corrective actions taken relative to this project:

q. Were You Ever Terminated for Convenience or for Default, Issued a Cure or Show Cause

Notice, Have an Option that was Not Exercised for Performance Reasons or Assessed Liquidated

Damages? If “yes”, provide explanation:

If the Role of the Offeror is Joint Venture Partner, Key Subcontractor, Subcontractor, etc. please continue to r) through x). Do not continue if the Role of the Offeror is Prime. Refer to your answer in c).

r. Offeror’s Subcontract Amount:

s. Subcontract Percentage of Total Prime Contract as listed in g) above:

t. Description of Work (e.g., facility reduction/demolition plans, contaminant abatement/removal, facility demolition/removal, site restoration):

u. Detailed Description of Work Self-Performed by the Offeror (to include what trades & specialties directly provided and percentage of total cost):

v. Describe any Work Subcontracted to Others by the Offeror (to include names, addresses, and values):

w. Reference (Client or Prime) Contact Information (includes POC name, address, phone, and email address):

x. If work supported involves multiple facilities and types, identify the percentage of total facilities square footage attributed to medical treatment facilities.

THIS IS A SAMPLE FORM FOR A FICTIONAL PROJECT IN ORDER TO

DEMONSTRATE A RESPONSE TO THE EXPERIENCE REPORTING FORM

Project Experience Tracking Number: 1 of 5

a. Project Title: FY18 Fort Swampy Demolition

b. Name of Offeror: Example Demolition Firm Inc.

c. Role of Offeror on this submitted project (Prime, Joint Venture Partner, Key Subcontractor, Subcontractor, etc.): Prime

d. Contract Number: W912DY-E-XAM-PLE-19

e. Location of Project: Fort Swampy, AL (Fictional Location)

f. Contracting Agency/Office or Customer: USACE – HNC

g. Contract Type and Pricing Arrangement: IDIQ Task Order – FFP

h. Contract Cost (to include breakdown of costs by modifications)

Original Award Amount: $1,000,000.00

Modification #1: $25,000.00 – Additional ACM found in wall cavities and removed

Modification #2: -$10,000.00 – Installation provided backfill from an adjacent project

Final Contract Price: $1,015,000.00

i. Contract Dates - (DD/MM/YYYY) - Award: 29/09/2017 Completed: 01/09/2018

j. Description of Work (e.g., facility reduction/demolition plans, ACM/ORM abatement/removal, facility demolition/removal, dismantling, site restoration): Provided

ACM/ORM abatement and demolition services for the USACE-HNC Faculties Reduction

Program at Fort Swampy, AL. The contract was for the removal of twelve facilities totaling

65,000SF. Site restoration was provided to ensure positive drainage and grass coverage over all disturbed areas.

k. Detailed Description of Work Self-Performed by the Offeror on this submitted project (to include what trades & specialties directly provided and percentage of total cost): The self-performed work includes project management, site supervision, site safety and health officer, and demolition services. These efforts resulted in 70% of the total cost of the contract.

l. Describe any Work Subcontracted by the Offeror to Others on this submitted project (to include names, addresses, and values): The subcontracted efforts include ACM/ORM abatement; 20%, and trucking; 10%.

m. Reference Contact Information (to include POC name, address, phone, and email address):

John Doe, 123 Corps Drive, Huntsville, AL; 123-456-7899, John.D.Doe@example.com

n. Describe how the work 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: The work performed is directly in line with the requested services of the solicitation; ACM/ORM Abatement and Demolition.

o. Contract Performance Evaluation Rating, if known: Acceptable

p. Describe past performance in terms of schedule, budget, quality control, safety, problems (if any) and corrective actions taken relative to this project:

1. Schedule - Acceptable

2. Budget - Acceptable

3. Quality Control - Acceptable

4. Safety – Acceptable

No corrective actions were necessary, requested, or taken.

q. Were You Ever Terminated for Convenience or for Default, Issued a Cure or Show Cause

Notice, Have an Option that was Not Exercised for Performance Reasons or Assessed

Liquidated Damages relative to this project? If “yes”, provide explanation: No on all counts.

If the Role of the Offeror is Joint Venture Partner, Key Subcontractor, Subcontractor, etc.

please continue to r) through x). Do not continue if the Role of the Offeror is Prime. Refer to your answer in c).

r. Offeror’s Subcontract Amount:

s. Subcontract Percentage of Total Prime Contract as listed above:

t. Description of Work (e.g. Facility Assessment, ACM/ORM Abatement, Demolition, Dismantling, etc.):

u. Detailed Description of Work Self-Performed by the Offeror on this submitted project (to include what trades & specialties directly provided and percentage of total cost):

v. Describe any Work Subcontracted to Others by the Offeror on this submitted project (to include names, addresses, and values):

w. Reference (Client or Prime) Contact Information (includes POC name, address, phone, and email address):

x. If work supported involves multiple facilities and types, identify the percentage of total facilities square footage attributed to medical treatment facilities.