Attachment J-2 Demonstrated Prior Experience Questionnaire

DEMONSTRATED PRIOR EXPERIENCE QUESTIONNAIRE

Region IX Emergency Medical Membership Access
Please complete the Demonstrated Prior Experience Questionnaire by providing the demographic and corporate experience information for your firm below. Quoters shall provide up to three (3) reference projects for ongoing projects or projects completed within the last three (3) years of the date of this RFQ demonstrating relevant experience performing projects similar in size, scope, and complexity to this IDIQ contract. A project is considered a single contract or task/delivery/call order, or a collection of orders under a BPA or IDIQ contract. The Quoter’s response must provide a clear, specific, and concise description of your relevant corporate experience that provides Federal and Commercial experience. Extraneous narrative, elaborate brochures, public relations (PR) material, etc. shall not be submitted. One questionnaire per prime/sub team combined or contractor teaming agreement (CTA), please indicate which firm’s experience is being demonstrated. The Government will assess the collective experience in each Quoter’s submittal. The Demonstrated Prior Experience Questionnaire must be submitted to the Contracting Officer (CO) – Keturah Stroy at [email protected] no later than 2:00 pm ET, December 14, 2026. (Page limit is five (5) pages using Times New Roman, font size 11.)

1. Firm Information

Name:
Address:
Name and Title of Representative:
GSA Schedule # (if applicable):
Phone:
E-mail Address:

2. Labor Categories provided under projects:

3. If teaming with another firm(s), list their name(s) and address(es): Item
Firm Name:
Firm Address:

Firm 1

Firm 2

Firm 3

(NOTE: If more than three partners are proposed, add the remaining information on a separate sheet of paper.)

4. Has this team worked together previously:

□ Yes □ No (If yes, fill out table below)

GSA Contract #
(if applicable):
Contract Period:
5. List up to three [3] projects which demonstrate the firm's or team's prior experience performing work similar to that required by the PWS using the format below: Item
Project Name and Location

Customer 1

Customer 2

Customer 3

Nature of the work
performed
Customer Name and Address
The Firm’s Project
Manager's Name and Phone
Number
Period of Performance and
Percentage Complete
Estimated or Final Value
Contract Type

6. Describe problems, failures, or data breaches that occurred during performance of the example and