PP_reference_form_fbo.doc

Attachment Solicitation Nr: 1605DC-19-Q-00234 Contractor/Offeror: ______________________________

ATTACHMENT

Solicitation Number: 1605DC-19-R-00067

PAST PERFORMANCE INFORMATION REFERENCE FORM

PART I: CONTRACTOR INFORMATION

Contractor’s Name:

Telephone Number:

Address:

Fax Number:

Point of Contact:

PART II: REFERENCE INFORMATION

REFERENCE #1:

Project Title/Description: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contract Number: _________________________Delivery/Task Order Nr:_______________ Point of Contact Name:

___________________Title: ______________________ Phone Number: _________________ Email: ____________________________ Contract Type:

Contract Dollar Value: (Base Year $____________) ($_____________, including all options) Contract Period/ Dates of Performance: ____________________ (base + all option periods) Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

REFERENCE #2:

Project Title/Description:

Contract Number:

_________________________Delivery/Task Order Nr:___________ Point of Contact Name:

___________________Title: ___________________ Phone Number: _________________ Email: ____________________________ Contract Type:

Contract Dollar Value: (Base Year $____________) ($_____________, including all options) Contract Period/ Dates of Performance: ____________________ (base + all option periods) Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

*Note: As necessary, the project title/description information may be provided on continuation pages (not to exceed the page limitation stated in the solicitation)

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