Attachment_3_-_Past_Performance_Reference.pdf

10 June 2013 Attachment 3

FA4855-13-R-0017

PAST/PRESENT PERFORMANCE REFERENCE

Provide the information requested in this form for each contract/program (citation) being described.

Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted. Limit the number of citations submitted and the length of each submission to the limitations set forth at paragraph 3.C.iv. of Addendum to FAR

Provision 52.212-1.

A. Company/Division Name: ________________________________________

B. Contracting Agency or Customer:____________________________________

C. Contract Number: _______________________________________________

D. Annual Contract Expenditures: _______________________________________

E. Period of Performance: ____________________________________________

F. Total Contract Value, including all modifications and options: ______________________

G. Primary Customer Points of Contact: (For Government contracts provide current information on the following individuals. For commercial contracts, provide points of contact fulfilling these same roles).

Contracting Officer

Name:

Office:

Address:

Tel. No.

Fax No.

Administrative Contracting Officer

Name:

Office:

Address:

Tel. No.

Fax No.

H. Brief desciption of contract effort, including number of separate and distinct commodities supplied under contract and whether the effort supported a multi craft facility maintenance operation providing building supplies, repair parts and system components to carpenters, electricians, heating, ventilation and air conditioning mechanics, plumbers, and entomologies.

10 June 2013 Attachment 3

FA4855-13-R-0017

I. Comments regarding compliance with contract terms and conditions: __________________________

J. Comments regarding any known performance deemed unacceptable to the customer, or not in accordance with the contract terms and conditions.