Contractor Past Performance Submittal Form.doc

CONTRACTOR PAST PERFORMANCE SUBMITTAL

CONTRACT NUMBER:

PROJECT ORGANIZATION OR COMPANY NAME:

CONTRACTING OFFICER NAME, PHONE AND/OR FAX NUMBERS:

Name:____________________________________________________________________________

Title: _____________________________________________________________________________

Phone: ___________________________________________________________________________

FAX: _____________________________________________________________________________

DOLLAR VALUE OF CONTRACT:

PERIOD OF PERFORMANCE (START-COMPLETION DATES)

DESCRIPTION OF ASBESTOS and LEAD BASE Paint Abatement WORK PERFORMED:

ANY PROBLEMS ENCOUNTERED/OFFEROR'S CORRECTIVE ACTIONS:

COMMENTS REGARDING COMPLIANCE WITH TERMS AND CONDITIONS OF CONTRACT SPECIFICATIONS:

COMMENTS REGARDING ANY KNOWN PERFORMANCE DEEMED NOT ACCEPTABLE TO THE CUSTOMER OR NOT IN ACCORDANCE WITH CONTRACT TERMS AND CONDITIONS, I.E., COST OVERRUNS, EXTENDED PERFORMANCE PERIODS, NUMEROUS WARRANTY CALLS, ETC.

Contractor: Submit one completed sheet for each relevant contract performed for Federal agencies and commercial customers within the last three years