6._Past_Performance_Data_Worksheet.pdf

(Attachment # 6)

REQUEST FOR QUOTE

DOG CARE SERVICES

WESTERN DISTRICT OF KENTUCKY

SOLICITATION NO.: 15M50018QA4400003

PAST PERFORMANCE DATA WORKSHEET

1. Name of Contracting Activity/Organization:

2. Contract Number:

3. Contract Type: Negotiated Sealed Bid Labor Hour (IDIQ Cost reimbursement Fixed Price Other

4 Total Contract Value: $

5. Status: Active Completed

6. Date of Award:

Original estimated completion date:

Actual completion date:

Explanation for variance:

7. Nature and Scope of the work:

8. Contracting Officer & Telephone Number:

E-mail address:

9. Program Manager & Telephone Number:

10. Administrative Contracting Officer (if different from #8):

11. Contracting Officer’s Representative (COR) and Telephone Number:

12. List of major subcontracts and their contribution to the overall value of the contract (percentage):

13. Any problems or mitigating circumstances which the offeror would like to have known to balance the evaluations of those named above:

A SEPARATE WORKSHEET MUST BE COMPLETED FOR THREE (3) FEDERAL

GOVERNMENT OR COMMERCIAL CONTRACTS PERFORMED DURING THE LAST 3 YEARS

THAT ARE SIMILAR AND RELEVANT TO THE PERFORMANCE REQUIREMENTS IN THE

SOLICITATION.

-USE ADDITIONAL PAPER IF NECESSARY-