47QFPA23R0001_Attachment_3-Reference_Information_Sheet_2023-02-28.docx

RFP ATTACHMENT 3

REFERENCE INFORMATION SHEET

(Note: Offerors are not to change the spatial structure of this form, i.e. borders, block size, etc.)

1. Complete Name of Reference (Government agency)

2. Complete Address of Reference

3. Contractor Name

4. Contractor Role (prime/subcontractor)

5. Contract Number or other control number

6. Date of contract

7. Date work began

8. Date work was completed or completion date if all options are exercised

9. Contract type, initial contract price, estimated cost and fee, or target cost and profit or fee

10. Final amount invoiced or amount invoiced to date

11a. Reference/Technical point of contact (name, title, address, telephone no. and email address)

11b. Reference/Contracting point of contact (name, title, address, telephone no. and email address)

12. Location of work (country, state or province, county, city)

13. Current status of contract (choose one):

[ ] Work continuing, on schedule [ ] Terminated for Convenience [ ] Work continuing, behind schedule [ ] Terminated for Default [ ] Work completed, no further action pending or underway [ ] Other (explain) [ ] Work completed, routine administrative action pending or underway [ ] Work completed, claims negotiations pending or underway [ ] Work completed, litigation pending or underway

14. Provide brief information describing the success of your firm in furthering the policy of the United States to maximize practicable opportunities for small business concerns, HUBZone small business concerns, small business concerns owned and controlled by socially and economically disadvantaged individuals, and small business concerns owned and controlled by women to participate in this contract.

15. When contracting with firms described in part 12 above, describe what, if any, procedures your firm established to ensure timely payment of amounts due.

16a. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes ___ , No ___.

16b. If “Yes” to 14a, have you regularly submitted Individual Subcontracting Reports (ISR)/Summary Subcontract Reports (SSR) on time? Yes ___ , No ___.

16c. Attach a copy of your most recently submitted ISR.

17 Provide a summary description of contract work, not to exceed 5 pages in length. Describe the nature and scope of work, its relevancy to this contract, and a description of any problems encountered and your corrective actions. Attach the additional information to this form.

RFP 47QFPA23R0001