Attach 5_PPIS.doc

ATTACHMENT 5

PAST PERFORMANCE INFORMATION SHEET

Vendor Name:

Street Address:

City & State (including 9-digit ZIP Code)

Complete and submit the information requested on five (5) contracts (completed or in progress) IAW Addendum to 52.212-1, Volume III – Past Performance, 1.3.10 and its subsections.

1. First Contract:

(a) Contracting Agency/Company:

(b) Point of Contact: Name:

Telephone No: ( ) _______

(c) Contract Number:

(d) Amount of Award: $

(e) Brief Description of Work:

(f) Performance Period:

(g) Scheduled Completion Date:

(h) Actual Completion Date:

(i) REMARKS, i.e., Problems encountered, modifications to contracts and reasons:

2. Second Contract:

Telephone No: ( )

3. Third Contract:

4. Fourth Contract:

5. Fifth Contract: