Attachment 02 Work References.doc

DOC document 77 KB Posted

Attached to
EAP SERVICES, CRANE ARMY AMMUNITION ACTIVITY Federal contract opportunity
Solicitation number
W519TC23QEAPS
Issued by
Department of the Army Materiel Command Contracting Command Rock Island Arsenal

About this file

This document is a work references form to be completed by offerors responding to solicitation number W519TC23QEAPS for EAP services at Crane Army Ammunition Activity. The form requests information on up to three previous contracts the offeror has performed as either a prime contractor, subcontractor, or joint venture partner. Details include the contract number, type of contract, title, location, award and completion dates, original and final prices, and percentage of work performed. Offerors must also provide a project description and explain how previous work is relevant to the EAP services required. Additionally, the form includes fields for customer information such as the company name, point of contact, title, phone number, email, role in the project, and date the questionnaire was completed.

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Text version

WORK REFERENCES FORM (Offeror to complete all blocks)

OFFEROR’s INFORMATION

1. Offeror’s Information

Firm Name:

Address:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain)

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

How is this project relevant to project of submission? (Provide details regarding client caseload size, and required technical and management skills)

CUSTOMER INFORMATION (Company for Whom the Work was Performed)

5. Customer Information Company Name/Address:

Point of Contact:

Title:

Phone Number:

Email Address:

6. Describe the customer’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

Revised April 2011

PAGE

Attachment 0002

SOURCE SELECTION SENSITIVE INFORMATION

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