RFP Attachment 5 - Reference Information Sheet.pdf

ATTACHMENT 5

REFERENCE INFORMATION SHEET

(Note: Offerors are not to change the spatial structure of this form, i.e. borders, block size, etc.)

N66001-16-R-0118 Source Selection Information—See FAR 2.101 and 3.104 27 April 2017

1. Complete Name of Reference (Government agency, commercial firm, or other organization)

2. Complete Address of Reference

3. Contract Number or other control number

4. Date of contract

5. Date work was begun

6. Date work was completed

7. Contract type, initial contract price, estimated cost and fee, or target cost and profit or fee

8. Final amount invoiced or amount invoiced to date

9a. Reference/Technical point of contact (name, title, address, telephone

no. and email address)

9b. Reference/Contracting point of contact (name, title, address, telephone no. and email address)

10. Location of work (country, state or province, county, city)

11. Current status of contract (choose one):

[ ] Work continuing, on schedule [ ] Terminated for Convenience [ ] Work continuing, behind schedule [ ] Terminated for Default [ ] Work completed, no further action pending or underway [ ] Other (explain) [ ] Work completed, routine administrative action pending or underway [ ] Work completed, claims negotiations pending or underway [ ] Work completed, litigation pending or underway

12. Provide brief information describing the success of your firm in furthering the policy of the United States to maximize practicable opportunities for small business concerns, HUBZone small business concerns, small business concerns owned and controlled by socially and economically disadvantaged individuals, and small business concerns owned and controlled by women to participate in this contract.

13. When contracting with firms described in part 12 above, describe what, if any, procedures your firm established to ensure timely payment of amounts due.

14a. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes ___ , No ___.

14b. If “Yes” to 14a, have you regularly submitted Individual Subcontracting Reports (ISR)/Summary Subcontract Reports (SSR) on time? Yes ___ , No ___.

14c. Attach a copy of your most recently submitted SF ISR.

15 Provide a summary description of contract work. Describe the nature and scope of work, its relevancy to this contract, and a description of any problems encountered and your corrective actions. Attach the explanation to this form.