JA-04_FA5004-16-R-C003_Past_Performance_Worksheet.pdf

PDF 14 KB Posted

Attached to
Simplified Acquisition of Base Engineer Requirements (SABER) Federal contract opportunity
Solicitation number
FA5004-16-R-C003-SABER
Issued by
Department of the Air Force Pacific Air Forces

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JA-04 Past Performance Worksheet

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(TO BE COMPLETED BY OFFEROR)

Offeror must complete a separate worksheet for each relevant contract. See Section L of the solicitation.

A. OFFEROR NAME: _________________________________________________________________________

OFFER ADDRESS: ________________________________________________________________________

OFFEROR CAGE CODE: _________________________________________________________________

B. CONTRACT NUMBER/TITLE: ______________________________________________________________

C. NAME OF CONTRACTING ACTIVITY OR CUSTOMER: _______________________________________

D. CONTRACT TYPE(S) (List all that apply - firm-fixed-price, time & materials, indefinite delivery, etc.)

E. CONTRACT $ VALUE: ORIGINAL _______________ CURRENT/FINAL _______________

CAUSE OF $ CHANGE _____________________________________________________________________

F. PRIME OR SUBCONTRACTOR? ___________________________________________________________

G. PROJECT DESCRIPTION: _________________________________________________________________

H. PERIOD OF PERFORMANCE: _____________________________________________________________

I. PRIMARY POINT(S) OF CONTACT (Contracting Officer, Manager, etc.)

NAME PHONE EMAIL

OFFEROR NAME:
OFFER ADDRESS:
OFFEROR CAGE CODE:
CONTRACT NUMBERTITLE:
NAME OF CONTRACTING ACTIVITY OR CUSTOMER:
CONTRACT TYPES List all that apply firmfixedprice time materials indefinite delivery etc:
CONTRACT VALUE ORIGINAL:
CURRENTFINAL:
CAUSE OF CHANGE:
PRIME OR SUBCONTRACTOR:
PROJECT DESCRIPTION 1:
PROJECT DESCRIPTION 2:
PROJECT DESCRIPTION 3:
PROJECT DESCRIPTION 4:
PERIOD OF PERFORMANCE:
NAME 1:
NAME 2:
NAME 3:
NAME 4:
NAME 5:
Text1: JA-04 FA5004-16-R-C003 Past Performance Worksheet

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