J4_Past_Performance_Data_Sheet.docx

Source Selection Information - See FAR 2.101 and 3.104

HQ0034-19-R-0057

Facilities Services Directorate Job Ordering Contract

PAST PERFORMANCE DATA SHEET

(Note: Offerors are not to change the spatial structure of this form, i.e. borders, block size, etc.)

1. Complete Name of Reference (Government agency, commercial firm, or other organization)

2. Complete Address of Reference

3. Contract Number or other control number

4. Date of contract

5. Date work was begun

6. Date work was completed

7. Contract type, initial contract price, estimated cost and fee, or target cost and profit or fee

8. Final amount invoiced or amount invoiced to date

9a. Reference/Technical point of contact (name, title, address, telephone no. and email address)

9b. Reference/Contracting point of contact (name, title, address, telephone no. and email address)

10. Location of work (country, state or province, county, city)

11. Current status of contract (choose one):

[ ] Ongoing [ ] Complete [ ] Terminated for Convenience [ ] Terminated for Default [ ] Other (explain)

12. Provide brief information describing the contract and the relevancy of the effort to be performed in accordance with the SOW and requirements of the solicitation. Provide an estimated % of relevancy of the referenced contract to the requirements set forth in this solicitation. Relevance shall address Pentagon Snow and Ice Removal Services. Relevance can be discussed in further detail on the attached summary description as set forth in block 14 below.

13. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes ____, No_____.

14. Provide a summary description of contract work, not to exceed two pages in length. Describe the nature and scope of work, its relevancy to this contract, and a description of any problems encountered and your corrective actions. Attach the explanation to this form.