N0018919QZ063_PastPerformanceInformationForm.doc

PAST PERFORMANCE INFORMATION FORM

Form ___ of ___

Name of Contractor that Performed:

Contract Number, order number, or identifier:

Government Name & Location:

Government Point of Contact (Name & Title):

Telephone Number (PLEASE VERIFY):

and e-mail address

Total dollar amount for this effort during the past five (5) years:

(For ordering vehicles, show both the annual estimated contract amount and the amount of orders actually performed):

(Show 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 solicitation:

Quality, delivery, or cost problem(s); corrective action(s) taken; and effectiveness of the corrective action(s):

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: