Attachment 1B Reference Information Sheet - Contract Specific Data.doc

ATTACHMENT 1B

REFERENCE INFORMATION SHEET – CONTRACT SPECIFIC DATA

SOLICITATION N65236-16-R-0021

(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):

FORMCHECKBOX

Work continuing, on schedule

Work continuing, behind schedule

FORMCHECKBOX

Work completed, no further action pending or underway

FORMCHECKBOX

Work completed, routine administrative

FORMCHECKBOX

Work completed, claims negotiations pending or underway action pending or underway

Work completed, litigation pending or underway

Terminated for Convenience

FORMCHECKBOX

Terminated for Default

FORMCHECKBOX

Other (explain)

12. Did this contract require a Small Business Subcontracting Plan (FAR 52.219-9)? FORMCHECKBOX Yes FORMCHECKBOX 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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