36C25618R0078-021.docx

ATTACHMENT D15 - Houma CBOC

PAST PERFORMANCE REFERENCES

REFERENCE 1:

Name of Government or Commercial Organization:______________________________ Address:_________________________________ Contract Number:______________________________ Brief Description:_________________________________________________________ Contractor Performed as: |_|Prime Contractor |_|Sub-Contractor Dates of Performance (if current include expiration):____________________ Total Cost of Contract:__________________Award/Incentive/Deduction_____________ Any terminations for cause or default? Circle YES or NO If yes, brief explanation:___________________________ Point Of Contact/COR:____________________________ Title:___________________________________ Telephone Number:____________________________ Point of Contact’s email address:______________________ Comments:_____________________________________________________________________________________________________________________________________

REFERENCE 2:

Name of Government or Commercial Organization:______________________________ Address:_________________________________ Contract Number:______________________________ Brief Description:_________________________________________________________ Contractor Performed as: |_|Prime Contractor |_|Sub-Contractor Dates of Performance (if current include expiration):____________________ Total Cost of Contract:__________________Award/Incentive/Deduction_____________ Any terminations for cause or default? Circle YES or NO If yes, brief explanation:___________________________ Point Of Contact/COR:____________________________ Title:___________________________________ Telephone Number:____________________________ Point of Contact’s email address:______________________ Comments:_____________________________________________________________________________________________________________________________________

REFERENCE 3:

Name of Government or Commercial Organization:______________________________ Address:_________________________________ Contract Number:______________________________ Brief Description:_________________________________________________________ Contractor Performed as: |_|Prime Contractor |_|Sub-Contractor Dates of Performance (if current include expiration):____________________ Total Cost of Contract:__________________Award/Incentive/Deduction_____________ Any terminations for cause or default? Circle YES or NO If yes, brief explanation:___________________________ Point Of Contact/COR:____________________________ Title:___________________________________ Telephone Number:____________________________ Point of Contact’s email address:______________________ Comments:_____________________________________________________________________________________________________________________________________