A22-16R0027-0003-ATT3-Experience_form.pdf

ATTACHMENT A

DATA SHEET FOR PERFORMANCE SURVEY

PURPOSE: Performance information relevant to RFP# W912P9-16-R-0027 for the acquisition of Bois Brule Pump Stations. Government RFP Point of Contact (POC): Barrietta Killiebrew Commercial Phone: (314) 331- 8514 Fax Number: (314) 331-8746

INSTRUCTIONS TO PRIME OFFEROR: Offerors shall complete one of these attachments for yourself and one for each division(s), major subcontractor(s), teaming partner(s), joint venture partner(s), or key person(s) the offeror wants the government to consider in the performance evaluation. YOUR NAME AND ADDRESS, AS THE PRIME OFFEROR, MUST APPEAR IN BLOCK 1 BELOW. Enter the name and address of the firm or individual you want surveyed in Block 2. If no name appears, only the firm or individual in Block 1 will be surveyed.

NOTE 1: Offerors shall complete a separate data sheet for each contract for itself (minimum of 3 up to a maximum of 5) and each additional entity the offeror wants the government to consider (up to a maximum of 5 for each entity). *For Key Personnel to be evaluated project information in the same format below shall be provided--resumes will not be Evaluated.

NOTE 2: Offerors shall submit this information with Volume I of their proposal. Offerors are encouraged, but not required, to provide copies to the Contracting Officer before the RFP closing date.

NOTE 3: Subcontractor consent release shall be completed for every major subcontractor(s), teaming partner(s), joint venture partner(s) or key person(s) whose performance the offeror wants the government to consider during the evaluation. Failure to complete the subcontractor consent form may result in information not being evaluated.

1. Name and address of Prime Contractor

REQUIRED

OFFEROR INSERT RESPONSES HERE

2. Name and address of subcontractor, team partner, joint venture or key person to be surveyed. INSERT “NONE” IF ONLY PRIME

CONTRACTOR WILL BE SURVEYED.

3. Name and address of agency holding the contract

4. Name and title of person to contact at the agency

5. Telephone number of POC in Block 4

6. Fax number of POC in Block 4

7. E-mail address of POC in Block 4, if known

8. Exact Contract/Project Title, Contract Number, and Contract Type (Firm Fixed Price, IDIQ, Cost Type, Cost plus Fixed Fee, MACC, MATOC, etc.)

9. Brief project description including discussion as to its relevancy to this acquisition (may be expressed as a percentage of the work to be performed (i.e. 30% paving, 40% design, etc.)

10. Dollar amount of project in Block 8 (include base price plus all options)

11. Period of performance and final contract completion date of project

SUBCONTRACTOR CONSENT:

We are currently participating as a (circle one): subcontractor, teaming partner, joint venture or key person with the prime contractor identified above in response to the referenced RFP. We understand the government is placing increased emphasis on performance in order to obtain best value. In order to facilitate the performance evaluation process, we are signing this consent form to allow you to discuss our performance with the prime contractor.