D1-Att_1-Past_Performance_Worksheet.pdf

Past Performance Worksheet

ATTACHMENT 3

Name of Contractor:

Solicitation Number:

1.Complete name of government agency, commercial firm or other organization

2. Complete address

3. Technical point of contact (name, address, telephone no. and e-mail address)

4. Contracting or purchasing point of contact

(name, address, telephone no. and e-mail address)

5. Contract number or other reference number

6. Date of contract

7. Date work was begun 8. Date work was completed

9 a. Initial contract price, estimated cost and fee, or target cost and profit or fee

9 b. Final amount invoiced or amount or amount invoiced to date

10. Is there a current Contractor Performance Assessment Reporting System (CPAR) report available: Yes No

11. Description of contract work (Describe nature and scope. Attach an explanation of any performance problems or other conflicts with the customer. Describe any litigation pending, on-going, or completed. Use a continuation sheet, if necessary.)

12. Current status of contract (choose one):

Work continuing, on schedule

Work continuing, behind schedule

Work completed, no further action pending or underway

Work completed, routine administrative action pending or underway

Work completed, claim negotiations pending or underway

Work completed, litigation pending or underway

Terminated for convenience

Terminated for default

Other (explain)

13. How many locations were/are supported in this contract?

No Locations supported

Up to 2 locations supported

At least 3 locations supported

More than 3 locations supported

14. How many recurring maintenance, repair, equipment calibrations, and supply service hours were utilized for each year of performance?