Attachment_1_-__Past_Performance_Information_Form.docx

Attachment 1 PAST PERFORMANCE INFORMATION FORM Contract Research Organization (Maximum Two References)

PAST PERFORMANCE INFORMATION FORM

Form ___ of ___

Name of Offeror:

Contract Number, Order Number, or Identifier:

Customer Name & Location:

Customer Point of Contact (Name & Title):

Telephone Number and e-mail address (PLEASE VERIFY):

Total dollar value for this effort broken into annual increments:

(For ordering vehicles, show both the annual estimated contract amount and the amount of orders actually performed) (Show the period of performance and dollars for that period) (*At least 1 year of performance must have been completed prior to the closing date of the solicitation):

If applicable, 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:

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: