Attachment 2 - Experience and Past Performance Form.pdf

This is an Experience and Past Performance form template issued by the General Services Office under the U.S. Department of State for Solicitation Number 19N06026Q0016. The form is designed as an addendum to FAR clause 52.212-1 and serves as a template for contractors to document their relevant past performance on similar projects.

The template requires contractors to provide information across five columns: the customer's name and address, telephone numbers for the customer's lead contract and technical personnel, the relevant contract number, a brief description of the work performed including specific responsibilities, and disclosure of any litigation currently in process or occurring within the last five years. The form includes multiple blank rows to allow contractors to list multiple past performance examples. No specific response dates, pricing information, set-asides, or award details are provided in this template document, as it functions solely as a data collection instrument for evaluating contractor qualifications and experience relevant to the solicitation.