PAST PERFORMANCE QUESTIONNAIRE New.docx

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: Offerors must identify previous federal, state, and local government and private contracts that they have completed and that are similar to the contract being evaluated. List at least three (3), for evaluation limited to the last three years. (One contract reference per form, Form may be duplicated) Any subcontractors to be used shall also include three forms each.

Contractor (you) Information:

Name: _____________________________________________________________________ Address: ___________________________________________________________________ Telephone Number: ___________________________________________________________ E-mail: ______________________________________________________________________

Contract Information:

Name of company/agency you provided service for: ___________________________________ Contract Number: _____________________________________________________________ Type of Contract: _______________________________________________________________ Contract Dollar Value: ___________________________________________________________ Date of Award: _________________________________________________________________ Status: Completed, Yes____ No____ If not completed, projected completion date____________ If not completed, why?___________________________________________________________ Were you the Prime? ________ were you the Sub? _______

Point of Contact Information for the company/agency you serviced:

Name of the Contract Person & their position: ________________________________________ Address: ______________________________________________________________________ Telephone Number: _____________________________________________________________ E-mail: ________________________________________________________________________

Description of Supply/Service(s) provided, location & relevancy of work:

Complexity of Product/Service, if any:

Percentage of Work completed by your company/by subcontractor:

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