Attachment_4,_Past_Experience_Questionnaire.pdf

PAST EXPERIENCE QUESTIONNAIRE

This acquisition is for the Maintenance and Repair of Motorpool Equipment and Systems in the Kaiserslautern Military Community.

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Address:

Telephone Number: ____________________

Email Address: ____________________

Point of Contact: ____________________

Project Title or Brief Description of Work*:

Contract Number*: Contract Amount:

Contract Period or Dates of Performance*:

Contractor performed as the Prime Contractor Sub-Contractor

To be completed by the respondent and returned directly to the contracting office.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

B. SPECIFIC EXPERIENCE INFORMATION:

What Type of Motorpool Equipment were cleaned: __________________________________________________

Description of Services Performed: _______________________________________________________________

Number of Household Appliances cleaned: ________________________________________________________

For Official Use Only

Attachment 4, Past Experience Questionnaire

FA5613-18-R-0016