12. Contractor Past Performance Submittal Form.pdf

FA3020-10-R-0041

Attachment 12

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

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 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.