Attachment 5 - Past Performance Information.pdf
PDF 141 KB Posted
- Attached to
- Portable Latrine and Handwash Station Cleaning
- Solicitation number
- FA527026QA017
About this file
This is a Past Performance Information form for RFQ No. FA527026QA017, issued by the 18th Contracting Squadron, U.S. Air Force, for Portable Latrine and Handwash Station Cleaning services. Offerors are required to submit past performance information demonstrating relevant experience performing services for the U.S. Government or private companies. The form requests specific contract details including contract number, customer name, contract amount (in Yen), period of performance, satisfactory rating, and designation of whether the offeror served as prime or subcontractor.
Satisfactory ratings are scored on a scale of 1 to 4, with ratings provided by the customer or company for which services were performed: 1 = Not Satisfied, 2 = Somewhat Satisfied, 3 = Satisfied, and 4 = Very Satisfied. Offerors must complete the table with all requested information, delete the provided example entry (contract FA527024P000X with 1 Special Forces Group, U.S. Army for 5,700,000 Yen from 1 January 2023 to 31 December 2023 with a rating of 3 as prime contractor), and submit a signed Certification Statement certifying the accuracy of the information. The completed form must be submitted as a PDF file, with the certification signed by an authorized company representative in either Japanese or English.
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Past Performance Information
RFQ No.: FA527026QA017, Portable Latrine and Handwash Station Cleaning
OFFEROR:
DATE:
Instructions to Offeror:
1. The purpose of this document is to provide past performance information to the 18th Contracting Squadron, U.S. Air Force, about your company, listed as OFFEROR. The information herein will be evaluated for technical acceptance by the requiring agency.
2. You may provide information on past performance, performed for the U.S. Government or private companies;
please ensure past performance is relevant to the services in the subject RFQ.
3. Past performance is an evaluation factor of your offer as stated in the RFQ.
4. Provide the information requested above to the best of your ability.
5. Satisfactor Rating is rated 1 to 4; ratings shall be provided to your company by the company/customer for which you performed; the ratings are as follows:
1 Not satisfied 2 Somewhat satisfied 3 Satisfied 4 Very Satisfied
6. An example (in blue text) is provided to you for reference. Delete this text prior to submission of this document.
7. For Prime or Subcontractor, please provide if you performed as the prime (P) or subcontractor (S) for the respective contract.
8. Questions regarding this form shall be directed the POCs listed in the RFQ document or as directed.
Contract Number Customer Contract Amount
(Yen)
Period of Performance (Start – End)
Satisfactory Rating
Prime or Subcontractor?
FA527024P000X
1 Special Forces
Group, U.S.
Army
5,700,000 1 Jan 23 – 31 Dec 23 3 P
Past Performance Information
9. For the Certification Statement, the individual by which this report was prepared must fill in their name in the blank space and sign their name on the line; Japanese or English is acceptable.
10. This document shall be submitted as a PDF file.
Certification Statement
I, ___________________________, on behalf of the listed company, hereby certify that the information provided herein is true and accurate.
SIGNATURE
TITLE/POSITION
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