Attachement J-4 Past Performance Information Form 11-18-19.docx
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- DHS-70RTAC18RFI000004
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Attachment 4
Past Performance Information Form (Quoters are required to complete this form for no more than three (3) separate relevant contracts/projects)
Quoter:
Company Group / Division:
Program, Project, Or Task Title:
REFERENCE INFORMATION
| 1 |
| Customer Name: |
| 2 |
| Address: |
Customer Info:
Contracting Contact
Program / Project Manager or COR
| 3 |
| Name & Title: |
| 4 |
| Organization: |
| 5 |
| Address: |
| 6 |
| Phone No.: |
| 7 |
| Fax No.: |
| 8 |
| E-mail: |
| 9 |
| Contract Number: |
| 10 |
| Contract Type (e.g. contract, BPA, order) and pricing type (e.g. fixed price, cost reimbursement): |
| 11 |
| Dollar Value (Not-to Exceed): |
Cumulative funded amount:
| 12 |
| Project Start Date |
Estimated/Actual Completion Date:
| 13 |
| Current status, e.g. completed and/or in progress |
Description of Work Performed and Relevance to Requirements in this RFP
Problems Encountered and Resolutions
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