Attachment 1(I) Past Performance Reference Sheet.pdf

DJM-13-A32-R-0003

PAST PERFORMANCE REFERENCE SHEET

Attachment J1(I) 1

1. Name of Contracting Activity/Organization:

2. Contract Number: ___________________________________________

3. Contract Type: Negotiated_______ Sealed Bid _______ Labor Hour (IDIQ) ________Cost Reimbursement __________ Firm Fixed Price__________ Other_____________

4. Total Contract Value: $______________________

5. Status: Active___________ Completed____________

6. Date of Award: _______________ Original estimated completion date: ________________ Actual completion date: _____________

Explanation for variance: ______________________________________________

7. Nature and Scope of the work: __________________________________________

8. Contracting Officer & Telephone Number: _________________________________ E-mail address: _______________________________________________________

9. Program Manager & Telephone Number: __________________________________ E-mail address: _______________________________________________________

10. Administrative Contracting Officer (if different from #8):

E-mail address: _______________________________________________________

11. Contracting Officer’s Technical Representative (COTR) and Telephone Number:

E-mail address: ________________________________________________________

12. List of major subcontracts and their contribution to the overall value of the contract

(percentage):

13. Any problems or mitigating circumstances which the offeror would like to have known to balance the evaluations of those named above:

14. Past Performance Information available in [ ] FAPIIS, [ ] PPIRS, [ ] CPARS, other _________________________________________________________________

DJM-13-A32-R-0003

PAST PERFORMANCE REFERENCE SHEET

Attachment J1(I) 2

IA SEPARATE REFERENCE SHEET MUST BE COMPLETED FOR THREE (3)

FEDERAL GOVERNMENT OR COMMERCIAL CONTRACTS PERFORMED

DURING THE LAST 3 YEARS THAT ARE SIMILAR AND RELEVANT TO

THE PERFORMANCE REQUIREMENTS IN THE SOLICITATION.

-USE ADDITIONAL PAPER IF NECESSARY-