Attachment 1B_15R0005.docx
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- N65236-15-R-0005
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ATTACHMENT 1B
REFERENCE INFORMATION SHEET – CONTRACT SPECIFIC DATA
SOLICITATION N65236-15-R-0005
((Reproduce this form as needed for each Contract Reference Cited)
NOTE: If submitting multiple orders under a single GSA, GWAC, DoD-wide contract or BPA in order to meet the relevancy threshold for a contract reference, offerors shall clearly identify the dates of performance and dollar amounts for each order.
1. Contract Number or other Control Number (Identify individual Task Orders if applicable):
2. Complete Name and Address of Contract Reference:
| Name: |
| Address: |
3. Date of Contract:
4. Date work began:
5. Date work was completed:
6. Contract Information:
Contract Type:
Initial Contract Amount (Total Ceiling):
Final (or Current) Contract Amount (Total Ceiling) (if different from Initial):
7. Final amount invoiced or amount invoiced to date:
8. Technical Point of Contact for this Reference:
| Name: | ||
| Telephone #: | ( ) - - | E-Mail: |
9. Contracting Point of Contact for this Reference:
| Name: | ||
| Telephone #: | ( ) - - | E-Mail: |
10. Location of work (country, state or province, county, city):
11. Current status of contract (choose one):
| |_| Work continuing, on schedule | |_| Work continuing, behind schedule | |||
| |_| Work completed, no further action pending or underway | |_| Work completed, routine administrative | |||
| |_| Work completed, claims negotiations pending or underway | action pending or underway | |||
| |_| Work completed, litigation pending or underway | |_| Terminated for Convenience |
|_| Terminated for Default |_| Other (explain)
12. Did this contract require a Small Business Subcontracting Plan (FAR 52.219-9)? |_| Yes |_| No If "Yes”, attach a copy of your most recently submitted eSRS Subcontracting Report for Individual Contracts, for the contract reference or, if no subcontracting plan required, provide a copy of your company’s Summary Subcontract Reports.
13. Provide contract specific technical capabilities data that addresses the subfactors and/or elements identified in provision L-317. Describe the nature and scope of work, its relevancy to this requirement, any proposed benefits of the experience to the Government, and a description of any problems encountered and your corrective actions.
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