36C78618Q0273-00003003.docx

BUSINESS MANAGEMENT QUESTIONNAIRE-/PAST PERFORMANCE

INSTRUCTIONS: Offerors must identify previous federal, state, and local Government and private contracts that they have completed and that are similar to the contract being evaluated. List at least three (3), but no more than five (5) contracts for evaluation limited to the last five (5) years.

(One contract reference per form, Form may be duplicated)

NOTE: If you have performed any National Cemetery Administration contracts list them first.

Contractor (you) Information:

Name: _____________________________________________________________________ Address: ___________________________________________________________________ Telephone Number: ___________________________________________________________ E-mail: ______________________________________________________________________ Contract Information:

Name of company/agency you provided service for: ___________________________________ Contract Number: _____________________________________________________________ Type of Contract: _______________________________________________________________ Contract Dollar Value: ___________________________________________________________ Date of Award: _________________________________________________________________ Status: Completed, Yes____ No____ If not completed, projected completion date____________ If not completed, why?___________________________________________________________

Were you the Prime contractor?______________ were you the Sub contractor? ___________