Attachment_4_-_Vendor_Past_Performance_Form.docx

ATTACHMENT 4 – VENDOR PAST PERFORMANCE FORM

When filled in this document is source selection sensitive information IAW FAR 3.104

Provide the information requested in this form for each project being described. Provide a description of the work that was performed on this contract that contains sufficient detail to enable an evaluator to determine relevancy (See RFP Section M for Relevancy Requirements). Provide a separate completed form for each contract/program submitted; no more than seven (7) forms may be submitted.

C. Department/Agency/Customer:________________________________________________________ D. Department/Agency/Customer Address:_________________________________________________ E. Name of Point of Contact:____________________ Alt Point of Contact: _____________________ F. Phone number of Point of Contact:_______________ Alt Point of Contact Phone: _______________ G. Was this work performed by the Offeror? ( ) Yes ( ) No H. If answering “No” to Question G. Provide the following:

(If Answering “Yes” to Question G, Proceed to Question J)

4. Is this entity identified as a subcontractor or a teaming partner in the Offeror’s response to Section L Paragraph 6.2.2? ( ) Yes ( ) No (NOTE: If contractor is using past performance of subcontractors or teaming partners, those teaming partners must be identified in the offerors response to RFP section 6.2.2.)

I. Dollar Value of Contract:____________________________________________________________

J. Project Period of Performance:________________________________________________________

K. Was the work performed on this project: (check all that apply)

L. For each of the required capabilities identified in the Performance Work Statement, illustrate how your experience on this program applies to each respective capability.