JA-4 - Past Performance Worksheet.docx

PAST PERFORMANCE WORKSHEET

11 Apr 2012

(TO BE COMPLETED BY OFFEROR)

Offeror must complete a separate worksheet for each relevant contract. See Section L of this RFP for detailed instructions.

A. OFFEROR NAME, ADDRESS, AND CAGE CODE: __________________________________

B. CONTRACT TITLE/NUMBER: __________________________________

C. NAME OF CONTRACTING ACTIVITY OR CUSTOMER: _____________________________

D. CONTRACT TYPE(S) – LIST ALL THAT APPLY (firm fixed price, time & materials, etc)

E. CONTRACT $ VALUE:

1. Original Value: ________________ and Current/Final Value___________________

2. Primary cause(s) of changes: _____________________

F. BRIEF DESCRIPTION OF EFFORT AS: _____________PRIME ___________SUBCONTRACTOR

As part of this narrative, highlight portions considered most relevant to the current acquisition addressing how and to what extent the proposed effort relates to the project or type of work identified in B above.

G. PERIOD OF PERFORMANCE: _____________________________

H. PRIMARY POINTS OF CONTACT (Contracting Officer, manager, other):

Name and Office Symbol Phone Number Fax Number

JA-4 Past Performance Worksheet

FA5004-12-R-C003

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