Attachment_10_Performance_Reference_Form.doc

Solicitation # FA4855-16-R-0006 Attachment 10 Performance Reference Form

Dated: 7 March 2016 Page | 1

PERFORMANCE REFERENCE FORM

1. Complete name of Government agency, commercial firm, or other organization

2. Complete address

3. Contract number or other reference

4. Date of contract

5. Date work was begun

6. Date work was completed

7. Estimated contract price

8.Total Contract Cost to date

9a. Technical point of contact (name, title, address, telephone no. and email address)

9b. Contracting or purchasing point of contact (name, title, address, telephone no. and email address)

10. Location of work (country, state or province, county, city)

11. Description of contract work (Describe how the work was similar in nature and scope of the work that is to be performed under the contract contemplated by the request for proposal). Attach an explanation of any performance problems or other conflicts with the customer. (Use a continuation sheet, if necessary.)

12. Current status of contract (choose one):

Work continuing, on schedule Terminated for convenience

Work continuing, behind schedule Terminated for default Work completed, no further action pending or underway Other (explain)

Work completed, routine administrative action pending or underway

Work completed, claims negotiations pending or underway

Work completed, litigation pending or underway

Instructions for Completing the Experience/Reference Information Sheet Item 1.

Insert the complete name the Government Agency, commercial firm or other organization for whom the work was performed.

Item 2.

Insert the customer’s complete address, including both post office box and street addresses, if applicable.

Item 3.

Insert any contract number or other contract reference used by the customer.

Item 4.

Insert the date on which the contract came into existence.

Item 5.

Insert the date on which you started to perform the work.

Item 6.

Insert the date on which the customer agreed that the work was satisfactorily completed. If work is ongoing insert the date of contract expiration.

Item 7.

Insert the total estimated contract price or value.

Item 8.

Insert the total cost of the contract, or the sum of all invoices to date.

Item 9a.

Insert the name, title, address, telephone no., and email address (if available) of the program or project manager or other customer technical representative who is most familiar with the quality of your work under the contract.

Item 9b.

Insert the name, title, address, telephone no., and email address (if available) of the contracting officer, purchasing agent, or other customer contracting or purchasing representative who is most familiar with your work under the contract.

Item 10.

Insert the location(s) where the work was performed.

Item 11.

Describe the nature and scope of the work. Include rationale supporting your assertion that the contract is recent and relevant and identify aspects of the contracts deemed recent and relevant and how they relate to the proposed effort. Past performance information must reflect recent, within the past six (6) years, and relevant experience. The objective is to show how the work that you did or are doing is similar in nature and scope to the work that is to be performed under the contract contemplated by the request for proposal. Describe any actions that you have taken to take to correct any shortcomings in your performance.