Attachment 23 - Past Performance Reference Info Sheet.docx

ATTACHMENT 23 – PAST PERFORMANCE REFERENCE

(Note: Offerors are not to change the spatial structure of this form, i.e. borders, block size, etc.)

1. Complete Name of Reference (Government agency, commercial firm, or other organization)

2. Complete Address of Reference

3. Contract Number or other control number

4. Date of contract

5. Date work was begun

6. Date work was completed

7. Contract type, initial contract price, estimated cost and fee, or target cost and profit or fee

8. Final amount invoiced or amount invoiced to date

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

9b. Reference/Contracting point of contact (name, title, address, telephone no. and email address)

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

11. Current status of contract (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

12. Describe your past performance in accordance with Sections L & M. Provide brief information describing the success of your firm in furthering the policy of the United States to maximize practicable opportunities for small businesses, small disadvantaged businesses (SDB), women-owned small businesses (WOSB), HUBZone businesses, and service disabled veteran-owned small businesses (SDVOSB) to participate in this contract.

13. When contracting with firms described in part 12 above, describe what, if any, procedures your firm established to ensure timely payment of amounts due.

14a. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes ___, No ___.

14b. If “Yes” to 14a, have you regularly submitted SF 294/295 reports on time? Yes ___, No ___.

14c. Attach a copy of your most recently submitted SF 294.

15. Provide CPARS evaluations for all portions of the past five (5) years on this contract, if available. If customer evaluations, other than CPARS were completed, please submit them. Otherwise, your references may be contacted by the Government to respond to Past Performance questions. (CPARS evaluations do not count towards page limits.)