HE125420R3001_Past Performance Questionnaire (Attachment 3).docx

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DoDEA Student Information System (SIS)
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HE125420R3001
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PAST PERFORMANCE QUESTIONNAIRE

SECTION I: CONTRACT IDENTIFICATION

1. Contractor: ________________________________________________________________

2. Cage Code of contractor contract was awarded to: _________________________________

3. Contract number: _______________________________________

4. Contract type (e.g., firm fixed price, cost plus, etc.): _____________________________

5. Was this a competitively awarded contract? Yes _____ No _____

6. Period of performance: __________________________________________________

7. Initial contract cost: $____________________________

8. Current/final contract cost: $_______________________________

9. Reasons for differences between initial contract cost and final contract cost:

10. Description of products/service provided:________________________________________

11. Geographic description of services under this contract, e.g., local, nationwide, worldwide, other Commands, etc.:_______________________________________________________

SECTION II. EVALUATOR AND AGENCY IDENTIFICATION

A. Agency (customer) name: __________________________________________________________________________ B. Evaluator's name and title: ____________________________________________________ C. Evaluator's phone number and email address: __________________________________________________________________________

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