JA-5_Past_Performance_Worksheet.pdf

PDF 68 KB Posted

Attached to
CH&PP Fire Alarm System Repair Federal contract opportunity
Solicitation number
FA5004-15-R-C006
Issued by
Department of the Air Force Pacific Air Forces

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JA-5 Past Performance Worksheet

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ATTACHMENT JA-5

FA5004-15-R-C006

PAST PERFORMANCE WORKSHEET

(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

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