Attachment 10 - Reference Information Sheet.pdf

RFP Attachment 10 Reference Information Sheet

N00167-22-R-0008 Source Selection Information See FAR 2.101 & 3.104 A10-1

Reference No. Select Reference No. that corresponds with Attachment 9, Organizational Experience Matrix

REFERENCE CONTACT INFORMATION

1. Complete Name of Reference (Government agency, commercial firm, or other organization) Click or tap here to enter text.

2. Complete Address of Reference (Government agency, commercial firm, or other organization) Click or tap here to enter text.

3. Technical Point of Contact of Reference Name: Click or tap here to enter text.

Title: Click or tap here to enter text.

Phone No.: Click or tap here to enter text.

Email: Click or tap here to enter text.

4. Contracting Point of Contact of Reference Name: Click or tap here to enter text.

Title: Click or tap here to enter text.

Phone No.: Click or tap here to enter text.

Email: Click or tap here to enter text.

REFERENCE CONTRACT INFORMATION

5. Control Number (e.g., Contract No.)

Click or tap here to enter text.

6. Task Order No. (if applicable) Click or tap here to enter text.

7a. Principle Contract Type:

Choose an item.

8. Contract Award Value (e.g., Contract price, Est. Cost & Fee, Target Cost & profit/fee (as applicable)) Click or tap here to enter text.7b. If Other, please specify:

Click or tap here to enter text.

9. Award Date (MM/DD/YY):

Click or tap here to enter text.

10. Reference Period of Performance (MM/DD/YY) Start Date: Click or tap here to enter text.

End Date: Click or tap here to enter text.

11. Contains Small Business Subcontracting Plan (FAR 52.219-9)? Choose an item.

STATUS OF REFERENCE

12. Actual Work Dates (MM/DD/YY) 13. Work Location:

Click or tap here to enter text.Start: Click or tap here to enter text.

End (if applicable): Click or tap here to enter text.

14. Current status of Work (choose one):

[☐] Continuing, on schedule [☐] Continuing, behind schedule [☐] Completed, no further action pending or underway [☐] Completed, routine administrative action pending or underway [☐] Completed, claims negotiations pending or underway [☐] Completed, litigation pending or underway

[☐] Terminated for Convenience [☐] Terminated for Default [☐] Other (explain)

15. Final Invoice Amount (if applicable): Click or tap here to enter text.

REFERENCE ORGANIZATIONAL EXPERIENCE INFORMATION

16. The Offeror ☐ certifies ☐ does not certify (choose one) that the summary description of contract work provided in response to Block 17 below only describes work performed since 01 January 2016.

17. Provide a summary description of the contract work explaining its relevance with respect to one or more of the Key Areas. Clearly format the response to separate the discussion for each Key Area. Do not provide a consolidated response for multiple Key Areas. In evaluating the offeror’s experience in each individual Key Area, the Government will consider only the text designated in the summary description of contract work for that particular Key Area.

The summary description provided for this Reference shall not be provided within this form. The summary description shall be provided as an addendum to this form meeting the formatting requirements of section L Instructions and page limitations set forth therein.

RFP Attachment 10 Reference Information Sheet

N00167-22-R-0008 Source Selection Information See FAR 2.101 & 3.104 A10-2