Sect J Exhibit 3 Past Performance Reference Worksheet.pdf

Section J, Exhibit 3

FA4407-11-R-0006

PAST PERFORMANCE REFERENCE WORKSHEET SUBMITTAL

(To be completed by offeror and submitted with proposal)

Provide a separate form for each reference, maximum of three (3).

A. Offeror Name: ____________________

B. Program/Project Title/Description: ____________________

C. Contract Specifics:

1. Name of Contracting Agency or Client/Customer___________________________________________

2. Contract Number __________________________

3. Contract Type __________________________

4. Period of Performance __________________________

5. Original Contract $ Value _________________

6. Current Contract $ Value __________________

7. If Amounts for 5 and 6 above are different, provide a brief description of the reason

D. Brief Description of Effort as __Prime or __Subcontractor

(Highlight portions considered most relevant to current acquisition)

E. Completion Date:

1. Original date: ____________________

2. Current Schedule: ____________________

3. Estimate at Completion ____________________

4. How Many Times Changed: ____________________

5. Primary Causes of Change: ____________________

F. Customer/client Points of Contact: (Contact information must be current. Evaluators will not attempt to locate or contact reference(s) with incorrect contact information.)

Project Manager: Name ____________________

Office ____________________

Address ________________________________________

Telephone ____________________

Contracting Officer: Name ____________________

Administrative Name ____________________