Attachment 3 - Past Performance Information Form.docx
DOCX document 19 KB Posted
- Attached to
- USCG MALLET DRY DOCK AND BARGE REPAIRS FY21
- Solicitation number
- 70Z085-21-Q-P45J6500
About this file
This solicitation requests quotes for ship repair services for the USCGC MALLET, a 75-foot inland construction tender, and an 84-foot construction barge. The Coast Guard seeks a contractor to furnish all necessary labor, materials, equipment and supplies to perform repairs on the cutter and barge from February 9 to April 20, 2021 at the contractor's proposed dry-dock facility within 650 nautical miles of Corpus Christi, Texas. Interested vendors must submit fixed-price quotes by 1:00 PM PST on November 6, 2020 via email. This requirement is set aside for small businesses with a NAICS code of 336611 and size standard of 1,250 employees. The solicitation includes attachments specifying the scope of work and repair items.
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Text version
Attachment 3
PAST PERFORMANCE INFORMATION FORM
Form ____ of ____
Name of Offeror:
Contract Number, Order Number, or Job identifier Reference:
Customer (Company) Reference Name & Address Location:
Customer Reference Point of Contact (Full Name & Title):
Customer Telephone Number and E-mail address:
(PLEASE VERIFY):
Total dollar value for this effort including all growth work (definite and option items)
(Show either each fiscal year or calendar year; and dollars):
Period of Performance (Month/Day/Year) From:
To:
No. of Period of Performance Time Extensions:
Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation:
Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by subcontractor(s), along with annual dollar value of all subcontracts:
Form ____ of ____
Name of Offeror:
Contract Number, Order Number, or Job identifier Reference:
Customer (Company) Reference Name & Address Location:
Customer Reference Point of Contact
Customer Telephone Number and E-mail address:
Total dollar value for this effort including all growth work (definite and option items)
(Show either each fiscal year or calendar year; and dollars):
Period of Performance (Month/Day/Year) From:
Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation:
Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by subcontractor(s), along with annual dollar value of all subcontracts:
Form ____ of ____
Name of Offeror:
Contract Number, Order Number, or Job identifier Reference:
Customer (Company) Reference Name & Address Location:
Customer Reference Point of Contact
Customer Telephone Number and E-mail address:
Total dollar value for this effort including all growth work (definite and option items)
(Show either each fiscal year or calendar year; and dollars):
Period of Performance (Month/Day/Year) From:
Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation:
Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by subcontractor(s), along with annual dollar value of all subcontracts:
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