JA-12 - Past Performance Worksheet.pdf

MAINTAIN TURBINE-GENERATOR #5 ATTACHMENT JA-12

EIELSON AFB, ALASKA PAST PERFORMANCE WORKSHEET

FTQW 12-1015 SOLICITATION FA5004-12-R-C005

PAST PERFORMANCE WORKSHEET

8 May 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