B.08 Appendicies D1-D3 21R5000 6.21.21.pdf

Source Selection Plan for RFP No. W912HP-21-R-5000 Cathodic Protection Services IDIQ

SOURCE SELECTION INFORMATION–SEE FAR 2.101 AND 3.104–FOR OFFICIAL USE ONLY

APPENDIX D1:

PROPOSAL DATA SHEET

NOTE TO OFFERORS

This OFFEROR PERFORMANCE CAPABILITY PROPOSAL DATA SHEET must be completed and attached as the first page of the body of your proposal. The information required by this data sheet may be completed directly on this form or attached to the form as supplemental data sheets.

1. NAME OF OFFEROR.

Name of Offeror(s):

If a joint venture or contractor-subcontractor association of firms, list the individual firms and briefly describe the nature of the association.

Firm 1:

Firm 2:

Nature of Association:

2. DUNS NUMBER FOR OFFEROR

(If more than one DUNS number is to be considered, explain affiliation to Offeror)

3. CCASS INDENTIFICATION FOR OFFEROR

4. AUTHORIZED NEGOTIATORS. FAR 52.215-11

5. CAGE CODE:

6. Tax ID#

The Offeror represents that the following persons are authorized to negotiate on its behalf with the Government in connection with this Request for Proposals (RFP). List names, titles, and telephone number of the authorized negotiator.

Name of Person Authorized to Negotiate:

Negotiator's Address:

Negotiator's Telephone:

SOURCE SELECTION INFORMATION–SEE FAR 2.101 AND 3.104–FOR OFFICIAL USE ONLY

APPENDIX D2:

PROJECT INFORMATION SHEET

Provide one (1) Project Information Sheet for each project submitted.

On an attached sheet, provide information for substantially complete or completed projects that meet the specified number, value, recency and relevancy criteria that have been or are being performed by the Offeror to be used for reference and evaluation purposes. Information provided is not limited to the space on this page, however responses are still subject to any page limitations stated elsewhere in the solicitation. For each project provide the following information:

Project Title:

Location:

Contract number (in the case of Indefinite Delivery type contracts, GSA contracts, and Blanket Purchase Agreements, include Delivery Order Numbers also):

Contractor Whom Performed the Project (include Cage Code and DUNS Number):

Nature of involvement in this project (i.e., Prime Contractor, Subcontractor, Other Role):

Procuring activity:

Procurement Point-of-Contact (name, telephone number and e-mail address):

Performance period (if completed, month/year start to month/year end; if active, month/year start, # of years completed to date, scheduled month/year end, current % complete w/”as of” date):

Address of project:

Name, address and telephone number of Project Owner:

Indicate type of project (Private Sector, Government, Planned Unit Development, etc.):

General description of project:

Brief narrative project summary Address how this project meets the relevancy criteria of this solicitation Cost/Price Data (must clearly indicate yearly price information) o Initial Award/Year 2/Year 3/etc.

o Modifications o Total cost

SOURCE SELECTION INFORMATION–SEE FAR 2.101 AND 3.104–FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION–SEE FAR 2.101 AND 3.104–FOR OFFICIAL USE ONLY

APPENDIX D3:

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0) CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name: CAGE Code:

Address: DUNs Number:

Phone / email::

Point of Contact (name/phone/email):

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number & Title:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: NAVFAC/USACE REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO USACE WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION

ON USACE SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES

DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO USACE.

PLEASE CONTACT THE OFFEROR FOR USACE POC INFORMATION. THE GOVERNMENT RESERVES THE

RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.