Attachment 12 Past Performance Information Form.doc

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Steel Ocean Buoys for USCG
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HSCG84-12-R-BHQ002
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RFP Attachment 12 Past Performance Information Form

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Solicitation: HSCG84-12-R-BHQ002

Attachment 12 – Past Performance Information Form

PAST PERFORMANCE INFORMATION FORM

Past Performance Information includes recent and relevant contracts for the same or similar service and other relevant information (including contract numbers, points of contact, and description of work). The Offeror shall furnish the information listed below for at least three (3) contracts, but not more than six (6), ongoing or completed within the last three years for like or similar services held with the U.S. Coast Guard or other Government agency.

The Government shall obtain past performance information from the sources provided to evaluate offers in accordance with the Evaluation Criteria.

REFERENCE #1

Name of Company/Organization:

Contract Number:

Period of Performance:

Point of Contract (Name):

Phone Number:

E-Mail Address:

Description of Work:

REFERENCE #2

Name of Company/Organization:

Contract Number:

Period of Performance:

Point of Contract (Name):

Phone Number:

E-Mail Address:

Description of Work:

REFERENCE #3

Name of Company/Organization:

Contract Number:

Period of Performance:

Point of Contract (Name):

Phone Number:

E-Mail Address:

Description of Work:

REFERENCE #4

Name of Company/Organization:

Contract Number:

Period of Performance:

Point of Contract (Name):

Phone Number:

E-Mail Address:

Description of Work:

REFERENCE #5

Name of Company/Organization:

Contract Number:

Period of Performance:

Point of Contract (Name):

Phone Number:

E-Mail Address:

Description of Work:

REFERENCE #6

Name of Company/Organization:

Contract Number:

Period of Performance:

Point of Contract (Name):

Phone Number:

E-Mail Address:

Description of Work:

The Government may use past performance information obtained from other than the sources identified by the offeror and the information obtained will be used for both the responsibility determination and the best value decision.

“Source Selection Information—See FAR 2.101 and 3.104.”

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