Attachment 3 - Past Performance Information Form.pdf
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- Attached to
- Dry Dock (DD): USCGC WYACONDA FY21 Repairs
- Solicitation number
- 70Z085-21-Q-P3086200
About this file
This solicitation requests quotes for ship repair services. The selected contractor will be awarded a firm fixed price contract to perform various drydock repairs on the USCGC WYACONDA, a 75-foot inland river buoy tender, at the contractor's proposed drydock facility between August 10, 2021 and October 19, 2021. The requirement is set aside for small businesses with a NAICS code of 336611 and size standard of 1,250 employees. Quotes are due by the date specified in the attached RFQ document and must include documentation of past performance, insurance, technical certifications, and subcontractor information as required. The Coast Guard is the contracting agency for these ship repair services.
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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:
PAST PERFORMANCE INFORMATION FORM Form ____ of ____
Name of Offeror:
Contract Number, Order
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
Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by
PAST PERFORMANCE INFORMATION FORM Form ____ of ____
Name of Offeror:
Contract Number, Order
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
Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by
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