Past_Performance_Reference_Form.pdf

PAST PERFORMANCE REFERENCE

INSTALLATION OF STAIRWELL VENTILATION AT CELEBREZZE FEDERAL BUILDING

CLEVELAND OHIO

Note: In accordance with the instructions contained in the paragraph entitled Description of Evaluation Factors, the

Offeror shall complete this form and submit as part of their proposal. Make additional copies as necessary and complete one form for each reference. Please number each sheet (e.g. 1 of 7, 2 of 7) based on the number of references that you are submitting (minimum of 2, no more than 7).

1. OFFEROR (COMPANY NAME) 2.

REFERENCE

NO.

OF

3. CONTRACT STATUS AND TYPE

CURRENT GOVERNMENT

PREVIOUS NON-

GOVERNMENT

4. PROJECT NAME AND LOCATION (BUILDING, CITY, STATE)

5. CONTRACT NUMBER (IF FEDERAL GOVERNMENT

CONTRACT)

6. CUSTOMER (COMPANY NAME OR

GOVERNMENT AGENCY)

7. CONTACT PERSON (NAME AND TITLE) 8. CONTACT PHONE NUMBER

9. ADDITIONAL CONTACT PERSON (NAME AND TITLE) 10. CONTACT PHONE NUMBER

11. TYPE OF FACILITY (office building, courthouse, hospital, school, etc.)

12. SIZE OF PROJECT (SQUARE FOOTAGE)

13. IS THE PROJECT FOR OR SIMILAR TO OFFICE

RENOVATION?

YES NO

14. VALUE OF THE PROJECT

15. IF COMPLETED PROJECT –

COMPLETED ON TIME?

YES NO (If No, explain on back)

15A. START DATE 15B. COMPLETION

DATE

15C. NUMBER OF

DAYS

16. DESCRIPTION OF PROJECT AND COMPLEXITY

17. LIST WHICH ELEMENTS OF THE PROJECT WERE SUBCONTRACTED

18. IDENTIFY HOW THIS PROJECT IS SIMILAR TO THE REQUIREMENTS OF THIS SOLICITATION