A23 Attachment - J4 Past Performance Data Sheet.docx

Solicitation Number: HQ003421R0039

UTILITY CLEANING AND PLUMBING PREVENTATIVE MAINTENANCE SERVICES

ATTACHMENT J4

Past Performance Data 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, commercial firm, or other organization)

2. Complete Address of Reference

3. Contract Number or other control number

4. Date of contract

5. Date work was begun

6. Date work was completed

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

8. Final amount invoiced or amount invoiced to date

9a. Reference/Technical point of contact (name, title, address, telephone no. and email address)

9b. Reference/Contracting point of contact (name, title, address, telephone no. and email address)

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

11. Current status of contract (choose one):

[ ] Ongoing [ ] Complete [ ] Terminated for Convenience [ ] Terminated for Default [ ] Other (explain)

12. Provide brief information describing the contract and the relevancy of the effort to be performed in accordance with the PWS and requirements of the solicitation. Provide an estimated % of relevancy of the referenced contract to the requirements set forth in this solicitation. Relevance shall address UTILITY CLEANING AND PLUMBING PREVENTATIVE MAINTENANCE SERVICES. Relevance can be discussed in further detail on the attached summary description as set forth in block 14 below.

13a. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes ____, No_____.

13b. If “Yes” to 13a, have you regularly submitted SF 294/295 reports on time?

13c. Attach a copy of your most recently submitted SF 294/295.

14. Provide a summary description of contract work, not to exceed two 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 explanation to this form.