Atch_4,_Past_Experience_Reference_Sheet.doc

Attachment 4

FA5613-17-R-0003

PAST EXPERIENCE REFERENCE SHEET

This acquisition is for Preventive Maintenance, Safety Inspections and Repairs of Hangar Doors, at Ramstein Air Base. .

A.

OFFEROR’S GENERAL INFORMATION:

Contractor’s Name:

Address:

Telephone Number:

Email Address:

Point of Contact:

Project Title or Brief Description of Work*:

Customer Point of Contact:____________________________

Customer Phone: ____________________

Contract Number*:

Contract Amount:

Contract Period or Dates of Performance*:

Contractor performed as the ( Prime Contractor ( Sub-Contractor

* Note: If offeror holds or has held other contracts with this agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B.

SPECIFIC EXPERIENCE INFORMATION:

Hangar Door Manufacturer(s): ____________________________________________________________________ Number of Doors Maintained: ____________________________________________________________________

Description of Services Performed: ________________________________________________________________

Dimensions of Largest Hangar Door Serviced on this contract: ___________________________________________

For Official Use Only