Attach_5_Past_Performance.doc

Attachment 5

Past Performance Information

Please supply THREE (3) past performance reference for work performed within the last three years of similar size and scope to the services indicated in the Performance Work Statement. The government reserves the right to contact individuals and companies/agencies other than those listed on this form to collect additional past performance information. Further, any information contained in the US Government’s Past Performance Information Retrieval System (PPIRS) may also be reviewed in the evaluation of past performance.

Company Information Company Name:

Address:

Phone:

Fax:

Email:

Reference Information #1

Company/Agency:

Current POC:

Phone:

Email:

Service/Product Provided:

Dollar Value of Contract:

Date of Contract Award:

Contract Number:

Documented Environmental Violations and Corrective Action Taken, if any:

Attachment 5 (Continued)

Reference Information #2

Company/Agency:

Current POC:

Phone:

Email:

Service/Product Provided:

Dollar Value of Contract:

Date of Contract Award:

Contract Number:

Documented Environmental Violations and Corrective Action Taken, if any:

Reference Information #3

Company/Agency:

Current POC:

Phone:

Email:

Service/Product Provided:

Dollar Value of Contract:

Date of Contract Award:

Contract Number:

Documented Environmental Violations and Corrective Action Taken, if any:

Past Performance Information Sheet