Att_04_140P8418Q0008_PP_Form.docx

Attachment 4, Past Performance and Relevant Experience Form RFQ No. 140P8418Q0008

PAST PERFORMANCE AND RELEVANT EXPERIENCE FORM

Island Septic / Vault Pumping and Disposal Services Channel Islands National Park RFQ No.: 140P8418Q0008

Offerors shall submit the following information:

Offerors Name: _________________________

Offerors Address: _________________________

Offerors DUNS: _________________________

Offerors Phone: _________________________

Offerors POC: _________________________

Offerors Signature: __________________________

PAST PERFORMANCE REFERENCES:

Name: ___________________________ Name:____________________________

Business: ___________________________ Business:__________________________

Address: ___________________________ Address:___________________________

Phone Number: ___________________________ Phone Number:_____________________

Name: ___________________________

Business: ___________________________

Address: ___________________________

Phone Number: ___________________________

LIST OF RELEVANT PROJECTS:

Contract # (if known): ___________________________

Agency/Owner: ___________________________

Contact Person: ___________________________

Phone Number: ___________________________

Amount: ___________________________

Performance Period: ___________________________

Contract # (if known): ___________________________

Agency/Owner: ___________________________

Contact Person: ___________________________

Phone Number: ___________________________

Amount: ___________________________

Performance Period: ___________________________

Contract # (if known): ___________________________

Agency/Owner: ___________________________

Contact Person: ___________________________

Phone Number: ___________________________

Amount: ___________________________

Performance Period: ___________________________