2.04r Attachment

Source Selection Plan

PAST PERFORMANCE INFORMATION FORM

Form _____ of _____

Name of Offeror:

Contract Number, order number, or identifier:

Location:

Title:

Telephone Number (PLEASE VERIFY):

and e-mail address Telephone number:

E-mail address:

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

(For ordering vehicles, show both the annual maximum 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 scope of the solicitation:

Scope:

Magnitude:

Complexity:

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.

SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104 For Official Use Only

Attachment (2)