36C78620Q0175-003.pdf

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), past 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: ___________________________________

Point of Contact (POC) Name:____________________________

POC Phone No.:__________________________

POC Email:__________________________________________

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? ___________