Past performance Information attch 15.doc

PAST AND PRESENT PERFORMANCE INFORMATION

Company Name:

Street Address:

City & State (including 9-digit ZIP Code)

Complete and submit the information requested on at least three (3) contracts (completed or in progress). All Government contracts are preferred; but, if you have not performed any Government contracts, indicate any other contracts performed or in progress.

1. First Contract:

(a) Contracting Agency/Company:

(b) Point of Contact: Name:

Telephone No: ( ) _______

(c) Contract Number:

(d) Amount of Award: $

(e) Brief Description of Work:

(f) Performance Period:

(g) Scheduled Completion Date:

(h) Actual Completion Date:

(i) Percent Completed:

(j) REMARKS, i.e., Problems encountered, modifications to contracts and reasons:

2. Second Contract:

Telephone No: ( )

3. Third Contract:

Telephone No: ( )

GENERAL FINANCIAL INFORMATION

The following information is requested to aid the Government in determining your financial responsibility.

If your answer to any question is “not applicable”, indicate “N/A”.

1. Name of Cognizant Audit Agency:_____________________________________________________

Mailing Address: ___________________________________________________________________

City & State (including 9-digit ZIP Code): _______________________________________________

2. Point of Contact: _______________________________Telephone No: ( )___________________

3. Dun & Bradstreet Rating (if known): _____________ 4. Date Company Organized: ___________

5. Company is a separate entity ( ) Division ( )If a division or subsidiary, provide name of parent company:

Name of Parent Company: ___________________________________________________________

6. Name of Your Bank: _______________________________________________________________

Mailing Address: __________________________________________________________________

City & State (including 9-digit ZIP Code): ______________________________________________ 7. Point of Contact: __________________________ Telephone No.: ( )_______________________

8. Do you have the equipment needed to perform the contract on which you are bidding? or do you have the resources to obtain the equipment? ( ) Yes ( ) No Explanation (if necessary):

9. What period does your fiscal year cover? _____________through______________________

10. What were the burden rates for your last fiscal year?

Overhead: ________% Profit: _____% General and Administrative (G&A): __________

11. Your estimates are based on historical job order system ( ), a standard cost system ( ), or OTHER ( ).

If “OTHER”, describe: ____________________________________________________________________________________

12. Estimating is performed by a separate department ( ), accounting department ( ), contract department ( ),or OTHER. If “Other”, describe: ____________________________________________

Typed/Printed Name of Preparer Title Signature Date

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