Attachment 5 - Past Performance List of Reference.pdf
PDF 140 KB Posted
- Solicitation number
- FA465925QM010
About this file
This document is a Past Performance List of References template for a federal solicitation (FA465925QM010) related to Petroleum, Oil and Lubrication Underground Storage Tank Testing. The two-page form is designed for contractors to document their previous contract experience, requiring detailed information about past performance, including contract numbers, description of work performed, contract periods, contracting agencies, point of contact details, and contract values. The template allows space for listing up to three reference contracts and provides an additional section to describe the role of any proposed subcontractors, affiliates, or joint ventures in the potential contract effort. The form is part of a small business set-aside solicitation for underground tank testing services at Grand Forks AFB, North Dakota, issued by the Department of the Air Force Air Mobility Command, with a NAICS code of 541380 and a size standard of $19.0 million.
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Text version
List of References
FA465925QM010
Petroleum, Oil and Lubrication Underground Storage Tank Testing
PAST PERFORMANCE LIST OF REFERENCES
Company Name:
CONTRACT NUMBER
(include task order number(s) if applicable)
DESCRIPTION OF WORK PERFORMED
(performed as a prime/sub-contractor, details i.e.
number of FTE, position type, full-time or session-based, %performed, etc. )
CONTRACT
PERIOD OF
PERFORMANCE
(POP)
CONTRACTING AGENCY
POC/CUSTOMER NAME, PHONE #
CONTRACT VALUES
(include total contract amount, annual amount and POP for annual amount)
PERFORMED BY A
PROPOSED
SUBCONTRACTOR
AFFILIATE, OR
JOINT VENTURE?
(If yes, please complete
Page 2)
Total: $
Annual: $
POP for Annual:
Total: $
Annual: $
POP for Annual:
Total: $
Annual: $
POP for Annual:
List of References
FA465925QM010
Petroleum, Oil and Lubrication Underground Storage Tank Testing
CONTRACT NUMBER
(include task order number(s) if applicable)
SUBCONTRACTOR,
AFFILIATE, OR
JOINT VENTURE
DESCRIBE FUNCTION/TASK/3RD PARTY AFFECT ON PERFORMANCE
1. If proposing to use a Subcontractor, Affiliate, or Joint Venture for this effort, include percentage of work, splitting of cost, type of services i.e. accounting, recruiting, etc they will perform for this effort (provide information below)
2. If contractor proposing on this effort provided past performance they performed as a Subcontractor, Affiliate, or Joint Venture, include percentage of work, splitting of cost, type of services performed, i.e. accounting, recruiting, etc for that effort (provide information below)
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