Past_Performance_Information_Form-ATTACHMENT 5.docx

HSCG85-15-Q-P45D82

PAST PERFORMANCE INFORMATION FORM

Form ___ of ___

Name of Offeror:

Contract Number, order number, or identifier:

Customer Name & Location:

Customer Point of Contact (Name & Title):

Telephone Number and e-mail address (PLEASE VERIFY):

Total dollar value for this effort broken into annual increments:

(For ordering vehicles, show both the annual estimated contract amount and the amount of orders actually performed) (Show either fiscal year or calendar year and dollars):

Number of personnel (FTE) performing per year (avg.):

To:

Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the scope of the solicitation:

Subcontractor(s) Utilized in Performance of this contract, description of the extent of work performed by subcontractor(s), along with annual dollar value of all subcontracts:

Attachment 5