Attachment 1(G) Past Performance Reference Sheet.doc

PAST PERFORMANCE REFERENCE SHEET

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: ________________________________

10.

Administrative Contracting Officer (if different from #8):

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 _______________________________________________________________ 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-

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Attachment J1(G)