Attachment 3 - Past Performance Information Form.docx
DOCX document 19 KB Posted
- Attached to
- USCG AXE and BARGE DRY DOCK REPAIRS FY21
- Solicitation number
- 70Z085-21-Q-P4556000
About this file
This document contains a federal contract solicitation requesting quotes for ship repair services. The U.S. Coast Guard is seeking a contractor to perform various repairs to its USCGC AXE, a 75-foot inland construction tender, and barge from April 1 to June 10, 2021 at the contractor's proposed dry-dock facility within 400 nautical miles of Morgan City, Louisiana. Services include all labor, materials, equipment, and tools necessary. Quotes are due no later than 1:00 PM PST on December 4, 2020 and shall be submitted electronically to the points of contact provided. The requirement is set aside for small businesses with a NAICS code of 336611 and size standard of 1,250 employees. The resulting contract will be fixed-price.
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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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