PPI Contract Reference Form.pdf

Solicitation Nr: DOL121RQ21504

ATTACHMENT 4

PAST AND PRESENT PERFORMANCE INFORMATION/QUESTIONNAIRE

CURRENT/PAST CONTRACT PERFORMANCE INFORMATION: Offeror to complete this part and return with Past Performance information in accordance with instructions in 52.212-1 volume

NOTEs:

1. A separate form must be completed for each contract performance reference.

2. Offeror’s are responsible for ensuring the information is complete, accurate, and up-to-date.

3. The Government reserves the right to not consider past performance information if contract reference data is not submitted via this form as requested.

CONTRACT REFERENCE # ______ (not to exceed 4) Offeror performed as the Prime Contractor Sub-Contractor Key Personnel

A. OFFEROR INFORMATION

Contractor’s Name:

Telephone Number:

Address:

Fax Number:

Point of Contact:

B. CONTRACT DATA (current/past performance within past three years of solicitation date) Contract Number:

Delivery/Task Order Nr:

Point of Contact Name:

Title:

Phone Number:

Email:

Contract Type:

Total Contract (Firm-Fixed Price ONLY):

Total Value of Order: $ Contract Performance Period (base year thru all options, as applicable)

C. PROJECT TITLE

D. DESCRIPTION OF PROJECT (Use space below and continuation page as necessary (not to exceed a maximum of two pages).