J-1-3_Past_Perf_and_Ref.xlsx

XLSX spreadsheet 12 KB Posted Jul 11, 2019

Attached to: Construction of the MAG Monitoring Center Building - Costa Rica
Solicitation number: 19AQMM19R0255
Issued by: Department of State Office of Acquisition Management

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J-1-3 Past Performance and Reference

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Past Performance References

		J-1-3 PAST PERFORMANCE & REFERENCES
Indicate the past performance information of the firm in similar projects performed in the last five (5) years. Include maximum 10 projects. Do not include certifications or contract copies. In the case it is needed it will be required thereafter.
	One	Two	Three	Four	Five
NAME OF THE CLIENT (CONTRACTING PARTY)
CLIENT ADDRESS
CLIENT TELEPHONE NUMBER
CLIENT POINT OF CONTACT (Name & Title)
POINT OF CONTACT EMAIL ADDRESS

CONTRACT NUMBER

TYPE OF CONTRACT( * 1)

NAME OF THE CONTRACT OR PROJECT

PROJECT LOCATION

PROJECT STARTING DATE

PROJECT FINISH DATE

WAS THE PROJECT FINISHED ON TIME ( Explain if needed)

SQUARE METERS OR UNITS (Indicate unit measurements)

CONTRACT COST IN PESOS

CONTRACT COST IN MONTHLY MINIMUM SALARIES

INDICATE IF IN THIS PROJECT YOU WERE THE PRIME CONTRACTOR , SUBCONTRACTOR OR ASSOCIATE

INDICATE THE PERCENTAGE OF PARTICIPATION OF YOUR FIRM IN THIS PROJECT

BRIEF DESCRIPTION OF ACTIVITIES BEING PERFORMED

COMPARISON OF THE WORK PERFORMED WITH THIS SOLICITATION ( *2 )

BRIEF DESCRIPTION OF TECHNICAL PROBLEMS ENCOUNTERED AND THE WAY THEY WERE SOLVED

METHOD OF ACQUISITION (Public solicitation, private or non competed) award criteria

COST/PRICE MANAGEMENT HISTORY (any cost overruns and under runs, and cost growth and changes)

HAVE YOU HAD ANY CONTRACT TERMINATIONS IN THE LAST TEN (10) YEARS?

REASONS FOR TERMINATIONS (for contractor convenience ó for default or other)

(*1)Consulting, construction, design, work oversight, delegated administration If you are not a company explain if you were the

superintendent, director or other.

(*2) Here you should indicate which activities performed are similar to the work being contracted.

I certify that the information is accurate and verifiable

Signature of the Legal Representative and Date Date

Name (Print) ID Number

Past Performance Questionnaire Attachment J-1-3

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