ATTACH4_-_SHORTPASTPERFORM.docx

ATTACHMENT 5

TABLE OF CONTACT

OFFEROR:

FIRM

POC

STREET ADDRESS

CITY - STATE

ZIP CODE

TELEPHONE #

FAX #

CELL #

EMAIL ADDRESS

l.2.2.2. Past PERFORMANCE EVALUATION FORM:

Provide a brief description of type of cargo, quantity, average # of trips, PT of Origin to Destination, Contract Amount that you have performed for other Federal Agencies or Private Firms.

Provide the following information:

a. Name of POC located at previous firm offerer worked for:

b. Title/Job Function

c. Agency/Company

d. Mail Stop/Suite

e. Address

f. City

g. State

h. Zip

i. Telephone Number

j. Fax Number

k. Zip Number

l. Contract Amount

m. Cargo Type

n. Quantity

o. Average # of trips

p. PT of Origin to Destination

Provide the following information:

a. Contract name

b. Contract number

c. Type of contract

d. Name of subcontractors used in Performance Record Questionnaire. Include:

Address City, State Zip Telephone, Fax

POC

e. Date of contract award

f. Contract End Date

g. Specify whether the contractor was the prime contractor or a subcontractor

h. If a subcontractor, specify the name of the prime contractor

a. Contract name

b. Contract number

c. Type of contract

d. Name of subcontractors used in Performance Record Questionnaire. Include:

Address City, State Zip Telephone, Fax

POC

e. Date of contract award

f. Contract End Date

g. Specify whether the contractor was the prime contractor or a subcontractor

h. If a subcontractor, specify the name of the prime contractor

Value of contract in dollars:

a. Original contract amount

b. Estimate of final

c. Expended to date

Description of past performance for this contract.