Attachment 5- Past Performance Questionnaire Final 31Jan2014.docx

DoD 4100.39-M Volume 10

ADDRESS: ________________________________________________________________________

CONTACT NAME:

TELEPHONE: FAX: EMAIL:

1. This Performance Data is to be used to evaluate your company’s past performance in meeting contract cost/price, technical and delivery objectives.

1. List Performance Data on your five (5) most recently completed Federal Government contracts (not to exceed three years since completion) for like or similar items required by this solicitation indicating highest Office Supplies sales. If you do not have 5 Federal Government contracts, then list state, local or commercial contracts, in that order, to complete this report. Submit as many copies of Attachment 5 as needed. You may submit more than 5 references if needed to depict the scope and variety of your performance however fewer than 5 references will result in a non-responsiveness determination.

1. CONTRACT NUMBER FOR REFERENCE : ______________________________

2. Awarded by:

2. Address:

2. City/State/Zip:

2. Contact Name

2. Telephone/FAX:

2. Contract Type:

2. Item Description:

2. Quantity:

2. Was consideration or a monetary withheld assessed against this contract for non-conforming supplies/services?

Yes* No

2. Was, or is, any part of this contract terminated for default or involved litigation?

Yes* No

2. Were all items delivered within the original contract schedule requirements?

Yes No*

2. Has your company received any quality awards in the past three years?

Yes* No

2. An invoice is attached for reference and information purposes.

Yes_ No

2. *For all answers with an asterisk (*), please provide an explanation. Describe any corrective actions initiated to solve any of the above-described problems/deficiencies on this contract. Discuss the success of the corrective actions taken.

10.3- Table 53