Attachment L3 Prior Experience Reference 250918.pdf
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- Solicitation number
- FMDS-2025-ChBA
About this file
This document is a confidential Reference Information form designed to capture details about an organization's prior contract experience. The template is divided into two parts: Part A focuses on contract summary information including respondent name, contract/reference number, contract type, competitive status, follow-on details, period of performance, and point of contact information. Part B provides fields for identifying an authorized representative, including their name, contact information, title, and signature. The form allows for documenting contract cost data such as estimated cost, fee, and total value, as well as a section for past performance narrative and product/service description. The form is intended to help capture comprehensive reference information for evaluating an organization's previous contract performance, with a clear note that the submitted information will be kept confidential.
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NOTE: THIS INFORMATION WILL BE KEPT CONFIDENTIAL
Reference Information - Provide the following information for your organization’s prior experience reference:
Part A. Contract Summary
1. Respondent Name: 2. Contract/Reference
Number:
3. Contract Type*: 4. Competitive*:
5. Follow-on*: 6. Period of Performance:
7. Contract/Reference POC Name:
8. Contract/Reference POC Telephone & Email
9. Contract Cost Data Estimated Cost Fee Total Value Initial Contract Cost $ $ $ Current Contract Cost $ $ $
10. Past Performance Narrative, Product Description and/or Supplies Provided
Part B. Identification of Authorized Representative
11. Authorized Representative Name:
12. Authorized Representative Telephone/Email:
13. Authorized Representative Title:
14. Date:
15. Authorized Representative Signature:
*Part A: Sections 3, 4, and 5 – As applicable.
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