Attchment 4 Past Performance Information Form.docx

PAST PERFORMANCE INFORMATION FORM

Form ___ of ___

Name of Offeror:

Contract Number, order number, or identifier:

Customer Name & Location:

Customer Point of Contact (Name & Title):

Telephone Number and e-mail address (PLEASE VERIFY):

Total dollar value for this effort broken into annual increments:

(For ordering vehicles, show both the annual estimated contract amount and the amount of orders actually performed) (Show the period of performance and dollars for that period) (*At least 1 year of performance must have been completed prior to the closing date of the solicitation):

Number of personnel (FTE) performing per year (avg.):

To:

Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation (If Helpdesk work was performed, indicate population of users supported, number of trouble tickets processed, and average turnaround time)

Scope:

Magnitude:

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: