A4_General_References_Form.pdf

P14PS01899 Page 1 of 2 PMIS 169303

General Reference

General References READ CAREFULLY: The purpose of this form is for the offeror to provide the Government with general references in the spaces provided as described in the Instructions, Conditions, and Notices to Offerors (Section L). Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their relationships with the references may be considered less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record. Provide explanations on separate sheets as necessary.

NAME OF CONTRACTOR/OFFEROR:

SURETY

Name of Surety:

Address of Surety:

Name of Agent:

Telephone Number:

CORPORATE BANK

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

CORPORATE BANK

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

INSURANCE COMPANY

Name:

Address:

Name of Agent:

Types of Policies:

P14PS01899 Page 2 of 2 PMIS 169303

General Reference

SUBCONTRACTOR

Address:

Name of Contact:

Area of Specialized Work:

Address:

Name of Contact:

Address:

Name of Contact:

MATERIAL SUPPLIER

Address:

Name of Contact:

Telephone Number:

Types of Material:

MATERIAL SUPPLIER

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material:

MATERIAL SUPPLIER

Name:

Address:

Name of Contact:

Types of Material: