Attachment_5,_Past_&_Present_Performance_Form.doc

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House Cleaning Services, All DoD MFH, Okinawa, Japan
Solicitation number
FA5270-17-R-0001
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Past & Present Performance Form

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PAST AND PRESENT PERFORMANCE FORM (Attachment 5)

FA5270-17-R-0001

Type of Services
Customer/Address
Performance Period
Contract

¥/$ Amount

Point of Contact
Tel No.
Fax No.
Remarks
House Cleaning Services
XYZ Corporation

1-2-3 Yamauchi, Okinawa City, Okinawa From: 1 Jan 2010

To: 31 Dec 2012

¥xxxxxxxxx
Mr. A. Yamada
098-868-xxxx
098-868-xxx

House Cleaning Services

18th Contracting Office

B-99, Kadena AFB, Okinawa, Japan

From: 1 Oct 2009 To: 30 Sep 2013

¥xxxxxxxxxx
Mr. B. Contracting
098-961-xxxx
098-961-xxxx

COMPANY/OFFEROR’S NAME: ________________________________________________________________

POC’s Name, Title and Signature: _________________________________________________________________

Date: _______________________________

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