Past_Experience_Reference_Form.doc

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HERBICIDE APPLICATION FOR USFWS CAROLINA SANDHILLS
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140F0419Q0113
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Past Experience Reference Form

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Solicitation: 140F0419Q0113

PAST EXPERIENCE & REFERENCES

REFERENCES

This form must be completed by all quoters/bidders in order to receive consideration. If additional space is needed, this form may be duplicated as necessary. List any current or past experience that is pertinent to this position. Past performance and experience may be a combination of up to three contracts similar in size and complexity to those stated in the Scope of Work and work experience in similar positions, performing duties similar in nature and complexity to the required services. Reference information should include a point-of-contact's name, telephone number and e-mail address.

Experience No. 1

Contract/Work type: ____________________________________________

Contract Number (if applicable): ____________________________________________

Total Contract Value: __________________________________________

Agency/firm for who work was performed: ____________________________________________

Contact person at the site: Telephone #: ____________________________________________

E-mail address: ____________________________________________

Month/Year work began: Month/Year work ended: ________________________________________

Brief description of duties:

Experience No. 2

Contract/Work type: ____________________________________________

Contract Number (if applicable): ____________________________________________

Total Contract Value: __________________________________________

Agency/firm for who work was performed: ____________________________________________

Contact person at the site: Telephone #: ____________________________________________

E-mail address: ____________________________________________

Experience No. 3

Contract Number (if applicable): ____________________________________________

Total Contract Value: __________________________________________

Agency/firm for who work was performed: ____________________________________________

Contact person at the site: Telephone #: ____________________________________________

E-mail address: ____________________________________________

Experience 4

Contract Number (if applicable): ____________________________________________

Total Contract Value: __________________________________________

Agency/firm for who work was performed: ____________________________________________

Contact person at the site: Telephone #: ____________________________________________

E-mail address: ____________________________________________

Submit NLT than the due date and time specified within this solicitation to: E-mail: constance_fields@fws.gov

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