Attachment_12_(Termination_Worksheet).doc

DOC52PAPT1300015

Attachment 12

Past Performance Contract Termination Worksheet

Prime/Subcontractor Name:

Termination for Convenience or Termination for Default?:

Customer/Agency:

Contract Name:

Contracting Officer Name, Email Address and Phone Number:

Type of Contract:

Area of Involvement:

Contract Award Date:

Contract Termination Date:

Awarded Contract Value:

11. Reason

Instructions

Termination Worksheet

The offeror is reminded that supplemental information is limited to one additional page face.

1.

Prime/Subcontractor Name:

Name of the Prime or Subcontractor that this termination applies to

2.

T/C or T/D:

Indicate whether this termination was for Convenience or Default. If it reverted to a T/C after being a T/D, please note this in the narrative section 11, “Reason:”

3.

Customer/Agency:

Name of the Customer or Agency that was involved in the T/C or T/D.

4.

Contract Name:

May be system name or title of contract

5.

Contract Officer Name & Government or commercial procurement contracting officer

Phone Number:

or official for this activity

6.

Type of Contract:

Examples: Cost Plus Award Fee, Fixed Price, etc.

7.

Area of Involvement:

Examples: System Engineering, System Architecture, etc.

8.

Contract Award Date:

Date the contract was awarded to the Prime/Subcontractor

9.

Contract Termination Date:

Date the contract was terminated

10.

Value:

Value of the contract at date of contract award

11.

Reason:

Explanation regarding the termination