Past_Experience_Past_Performance_Form.docx

ATTACHMENT I

PAST EXPERIENCE/PAST PERFORMANCE

REFERENCE INFORMATION FORM

1. Complete name of Government agency, commercial firm, or other organization

2. Complete address

3. Order number or other reference

4. Date of Order

5. Date work was begun

6. Date work was completed

7. Estimated Order price

8. Final amount invoiced or amount invoiced to date

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

9b. Ordering or purchasing point of contact (name, title, address, telephone no. and email address)

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

11. Description of Order work (Describe the nature and scope of the experience and provide an explanation of how the work is the same or similar to the work required by the USITC). Attach an explanation of any performance problems or other conflicts with the customer. Use a continuation sheet, if necessary.)

12. Current status of Order (choose one):

Work continuing, on schedule Terminated for convenience Work continuing, behind schedule Terminated for default Work completed, no further action pending or underway Other (explain) Work completed, routine administrative action pending or underway Work completed, claims negotiations pending or underway Work completed, litigation pending or underway

Instructions for Completing the Experience/Reference Information Sheet Item 1: Insert the complete name of the Government Agency, commercial firm or other organization for whom the work was performed.

Item 2: Insert the customer’s complete address, including both post office box and street addresses, if applicable.

Item 3: Insert any Order number or other Order reference used by the customer.

Item 4: Insert the date on which the Order came into existence Item 5: Insert the date on which you started to perform the work.

Item 6: Insert the date on which the customer agreed that the work was satisfactorily completed. If work is ongoing insert the date of Order expiration.

Item 7: Insert the total estimated Order price or value.

Item 8: Insert the final sum of all invoices, or the sum of all invoices to date.

Item 9a: Insert the name, title, address, telephone no., and email address (if available) of the program or project manager or other customer technical representative who is most familiar with the quality of your work under the Order.

Item 9b: Insert the name, title, address, telephone no., and email address (if available) of the contracting officer, purchasing agent, or other customer contracting or purchasing representative who is most familiar with your work under the contract.

Item 10: Insert the location(s) where the work was performed.

Item 11: Describe the nature and scope of the 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 Order contemplated by the request for proposal. Describe any unusual circumstances of performance or problems that may be relevant to the work that is to be performed. Tell your 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 to take to correct any shortcomings in your performance.