J-03 attachment.pdf

LED PAR-38 and PAR-56 Screening Information Request Number: 693KA8-23-R-00009

3.0 PAST EXPERIENCE INFORMATION FORM

PAST EXPERIENCE INFORMATION FORM

(To be completed by Contractor)

1. Contractor:

Name:

Address:

2. Contract /Task Order(TO) /Purchase Order (PO) Number:

3. Contract/TO/PO Dollar Value:

4. Contract/TO /PO Status: Active Complete

Completion Date (w/ extensions):

5. Project Title:

Location:

6. Project Description-- to include the role of the contractor on the project and specific responsibilities of the contractor in performance of the effort:

7. Project Owner or Project Manager for the Client (provide reference):

Name:

Address:

Telephone Number and E-mail: