D21 PAST PERFORMANCE REFERENCES.docx

Attachment D21 – Past Performance References

Reference 1:

Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments:

Reference 2:

Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments:

Reference 3:

Name of Government or Private Organization: _______________________________________ Address: ____________________________________________________________________ Contract number: ___________________________________________ Brief Description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contractor Performed as: Prime contractor Sub-contractor Dates of Performance (if current include expiration date): ______________________________ Total Value of the Contract: ________________________________________ Any terminations for cause or default? Circle Yes or No If yes, briefly explain: __________________________________________________________ Any contract discrepancy reports filed? Circle Yes or No If yes, briefly explain: __________________________________________________________ Point of contact/COR name: _________________________ Title: ____________________________________ Telephone number: __________________________ Point of contact/COR e-mail address: _________________________ Comments: