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PAST PERFORMANCE QUESTIONAIRE

INSTRUCTIONS: Contractor must identify previous federal, state, local government and or private contracts completed that are similar in size and scope to the contract being evaluated. List at least three

(3) contracts for evaluation. Contracts must be either competed or current within the last (5) years.

One contract reference per form. Contract must be Relevant to current requirements.

Note: List any National Cemetery Administration (NCA) contracts currently working or previously worked first followed by Non‐NCA contracts.

Past Performance Questionnaire

Contract Number

Contractor ( Name

Address, Zip Code)

Telephone Number

Email Address

Type of Contract

Contract Dollar Value

Date of Award (if not completed provide status)

Type/Extent of

Subcontracting

Percentage of Work completed by the

Contractor

Description of

Supply/Services provided, location & relevancy of work

Address, Telephone

Number & Email of the

Contact Person and

Position

Form may be duplicated

File details come from the government source that posted it. Updated .