Reference_Information_Sheet.doc

Contractor shall complete and submit THIS FORM with offer.

REFERENCE INFORMATION

SOLICITATION NumBER:

HSCG42-16-PCV395

Date company information (Company name, address) Does company accept government credit card, Visa payment procedures: Y_____ / N ______ Active registration with the System for Award Management (SAM)? Y_____ / N_____(If no, SAM registration must be completed and proof provided w/offer). Provide your Dun & Bradstreet No (DUNS):____________________________ & TIN:_____________________________ telephone number:

cell phone number:

facsimile number:

e-mail address:

1. List experience in this type of work

2. Have you ever been terminated from any job? (If YES, give reason)

3. do you anticipate any difficulties finishing this job on time? (If YES, give reason)

4. percentage of work to be subcontracted

6. REFERENCES Offer shall furnish the information listed below for like of similar contracts held with the U.S. Coast Guard, other Government Agencies or private industry. Failure to furnish this information may result in a determination of non-responsibility. (LIST THREE)

6a.

Reference #1:

Company name

Person to contact

Address

Telephone no.

Project

6b.

Reference #2:

6c.

Reference #3:

Previous versions are useable TRACEN CAPE MAY REFERENCE INFORMATION FORM (Rev. 01/01)

Attachment (5)