12. Past Performance Information Form.docx

FA9401-12-R-0019 ATTACHMENT 12

PAST PERFORMANCE INFORMATION FORM

EXPERIENCE INFORMATION

(To be completed by Offeror)

1. Contractor:

Address:

DUNS Number:

Point of Contact:

Telephone:

Email:

Point of Contact:

Telephone:

Email:

2. Contract /Task Order(TO) /Purchase Order (PO) Number:

3. Contract/TO/PO Dollar Value:

Contract Completion Dollar Value:

4. Contract/TO/PO Status:

|_| Active |_| Complete

Percent (%) complete and scheduled completion date (if active):

Completion Date (if 100% complete):

5. Project Title: |_| Prime |_| Subcontractor

Location (City and Province):

6. A. Project Description / Scope of Work that the Offeror completed:

B. Provide a short narrative on any adverse issues associated with the completion of this project, if applicable.