Attachment_5-Past_Performance_Form.pdf

ATTACHMENT 5-Past Performance Reference Form

Source Selection Information See FAR 2.101 and 3.104

PAST PERFORMANCE INFORMATION FORM

Page ___ of ___

Name of Vendor:

Contract Number, order number, or identifier:

Contract Type (Firm Fixed Price, Cost Reimbursement, or Time and Material):

Government/Employer Point of Contact (Name & Title):

Government/Employer Telephone Number and e-mail address

(PLEASE VERIFY):

Total dollar value for this effort broken into annual increments:

(For ordering vehicles, show both the annual estimated contract amount and the amount of orders actually performed)

Type of Service(s) Provided and location(s) : Period of Performance:

From:

To:

Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation:

(NOTE: Vendor should demonstrate that the efforts performed for this reference are similar or directly related to janitorial services)

Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by subcontractor(s), along with annual dollar value of all subcontracts: