Attachment E - Past Perfomance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: Offerors must identify previous federal, state, local government, and or private contracts completed and that are similar in size and scope to the contract being evaluated. List at least three (3), but no more than five (5) contracts performed within the last three (3) years. (One contract reference per form; Form may be duplicated)

NOTE: List any National Cemetery Administration (NCA) contracts currently working or previously worked first followed by Non-NCA contracts.

Contractor (you) Information:

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

Telephone Number: ___________________________________________________________________

E-mail: ______________________________________________________________________________

Contract Information:

Name of company/agency you provided service for: __________________________________________

Contract Number: ____________________________________________________________________

Type of Contract: _____________________________________________________________________

Contract Dollar Value: _________________________________________________________________

Date of Award: _______________________________________________________________________

Status: Completed, yes____ No____ If not completed, projected completion date___________________

If not completed, why? _________________________________________________________________

Were you the Prime? ________ were you the Sub? _______

Point of Contact Information for the company/agency you serviced:

Name of the Contract Person & their position: _______________________________________________

Address: ____________________________________________________________________________

Telephone Number: ___________________________________________________________________

E-mail: _____________________________________________________________________________

Description of Supply/Service(s) provided, location & relevancy of work:

Complexity of Product/Service, if any:

Percentage of Work completed by your company/by subcontractor: (If less than 100%, please explain the tasks you performed.)