Attachment-Past_Performance_Form.pdf

Attachment 1- Past Performance Form

Agency Name:

POC (Contract representative, Project/Program Manager, or Technical representative)

Name and Title:

Phone:

Email:

Period of Service

From: To:

Contract Type (Firm Fixed Price, Time &

Materials; Cost Reimbursable, etc., Cost plus award fee, etc.):

Contract Value: $

Brief project description and title:

Would you award a contract to this company again given a choice? Yes or No Circle their performance rating:

Excellent Good Acceptable Fair Poor

Explain:

Print Name Title Signature Date

Return Completed form to Trevor.Simon@gsa.gov