Attachment 2 - PAST PROJECT FORM.doc

HSHQEH-11-R-00007

Attachment 2

PAST PROJECT FORM

1. Name of Vendor

1a. Solicitation Number (i.e. the solicitation your firm is responding to)

2. Complete Name of Government Agency, Commercial Firm, or other Organization for which effort was performed.

3. Complete Address of entity named in #2 above

4. Contract Number or Other Reference

5. Date of Project Award

6. Total Project Price (to include all options)

7. Period of Performance (to include all options)

8a. Technical point of contact (name, title, address, telephone no., and email address)

8b. Contracting or purchasing point of contact (name, title, address, telephone no., and email address)

9. Geographic Location of work (Country, State or Province, County, City)

10. Description of contract work. In order to establish the relevance of your project to the instant requirement, please describe the scope, magnitude and complexity of this work, comparing and contrasting it to that required under this solicitation. Additionally, describe any unique or unusual requirements of the contract, and performance problems or issues encountered under the performance of the contract. Include discussion of any previous or ongoing Department of Labor investigations of your firm for Service Contract Act or other labor related violations. For problems/issues noted, describe the method of resolution and/or corrective actions taken. Use a continuation sheet, if necessary.

11. Name(s) of subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s).

Instructions for Completing the Past Project Form

Item1 Insert Name of Offeror

Item 1a Insert Solicitation Number

Item 2 Insert the complete name of the customer, including parent organization. Do not use acronyms.

Item 3 Insert the customer's complete address, including both post office box and street address, if possible.

Item 4 Insert any contract number or other contract reference used by the customer.

Item 5 Insert the date on which the contract came into existence.

Item 6 Insert the price, as it appeared in the original contract inclusive of all option periods. If the contract included multiple, separately-priced items, add the individual item amounts and insert the total price.

Item 7 Insert the period of performance to include all option periods (if applicable).

Item 8 Insert the name, title, address, telephone number and email address of the contracting officer or other point of contact, Item 8a Insert purchasing agent or other customer contracting or purchasing representative who is most familiar with your work under the contract.

Item 9a Insert the location where the work was performed, including the country (if other than the United States) and the state or province, county and city.

Item 10 Describe the nature and scope of work. The objective is to show how the work that you did or are doing is similar in nature and scope to the work that is to be performed under the contract contemplated by the request for proposal. Describe any unique or unusual requirements of the contract and any problems encountered during the performance of this contract work. Tell you side of the story of any conflicts with the customer concerning which they may make adverse remarks about your performance. Describe any actions that you have taken or plan to take to correct any shortcomings in your performance Item 11 Insert the name, address, telephone number, and email address (if available) of the subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s).

Enclosure 1