Attachment 3 - Past Performance Information Form.docx

DOCX document 19 KB Posted

Attached to
USCGC WILLOW (WLB-202) DS FY23
Solicitation number
70Z08523QLREP0002
Issued by

About this file

This document contains a federal solicitation for dockside repair services for a Coast Guard cutter. The solicitation requests quotes for repairs to be completed between January 2nd and March 13th, 2023 at a facility in North Carolina. Small businesses are eligible to compete for this set-aside procurement. Offerors must submit quotes by November 14th, 2022 detailing their proposed costs to provide the labor, materials, and equipment specified in the attached statement of work. The solicitation also provides contact information for questions and instructions on submitting quotes. Site visits to inspect the vessel will be held by October 28th to facilitate quote development.

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Text version

Attachment 3

PAST PERFORMANCE INFORMATION FORM

Form ____ of ____

Name of Offeror:

Contract Number, Order Number, or Job identifier Reference:

Customer (Company) Reference Name & Address Location:

Customer Reference Point of Contact (Full Name & Title):

Customer Telephone Number and E-mail address:

(PLEASE VERIFY):

Total dollar value for this effort including all growth work (definite and option items)

(Show either each fiscal year or calendar year; and dollars):

Period of Performance (Month/Day/Year) From:

To:

No. of Period of Performance Time Extensions:

Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation:

Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by subcontractor(s), along with annual dollar value of all subcontracts:

Form ____ of ____

Name of Offeror:

Contract Number, Order Number, or Job identifier Reference:

Customer (Company) Reference Name & Address Location:

Customer Reference Point of Contact

Customer Telephone Number and E-mail address:

Total dollar value for this effort including all growth work (definite and option items)

(Show either each fiscal year or calendar year; and dollars):

Period of Performance (Month/Day/Year) From:

Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation:

Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by subcontractor(s), along with annual dollar value of all subcontracts:

Form ____ of ____

Name of Offeror:

Contract Number, Order Number, or Job identifier Reference:

Customer (Company) Reference Name & Address Location:

Customer Reference Point of Contact

Customer Telephone Number and E-mail address:

Total dollar value for this effort including all growth work (definite and option items)

(Show either each fiscal year or calendar year; and dollars):

Period of Performance (Month/Day/Year) From:

Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation:

Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by subcontractor(s), along with annual dollar value of all subcontracts:

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