Past Performance Reference Information Form.docx

Past Performance Reference Information Form (Completed Form limited to 3-5 pages per reference contract.)

1. Name and Unique Entity Identifier (UEI) of Offeror Submitting Proposal:

2. Name of Reference Contract Client (e.g., Government Agency or Prime Contractor):

3. Name and UEI of Entity Reference Contract Was Awarded To: (if the Entity was made up of member companies, provide the applicable member company’s name and UEI as well)

5. Reference Contract Number:

Reference Contract Title:

6. Reference Contract Client Point of Contact:

*The reference point of contact must include the Contract/Subcontract Lead (or equivalent) and may also include the Project Director or Technical Representative (or equivalents).

Name:

Title:

Telephone:

Address:

Email:

7. Reference Contract Period of Performance:

8. Reference Contract Type (e.g., Fixed-Price Contract (FP), Time and Materials Contract (T&M), Cost Reimburement, Indefinite Delivery Indefinite Quantity (IDIQ), Blanket Purchase Agreement (BPA), Basic Ordering Agreement (BOA), etc.):

9. Reference Contract Total Value and Approximate Average Annual Value

10. Reference Contract Value Performed to Date (Insert the final sum of all invoices, or the sum of all invoices to date, including agreed upon and disputed amounts, paid and awaiting payment; Date = RFP release date):

11. Complexity (Summary Scope, Difficulty of Work, Similarity to this Work Scope, problems encountered and creative solutions with respect to corrective actions taken.

Safety statistics: The Offeror shall demonstrate its commitment to maintaining safe work practices in the performance of the Work. This may include a summary of the Offeror’s safety program, relevant policies, and overall safety performance. Where applicable, the Offeror may also provide general information regarding the safety practices of any proposed lower-tier subcontractors.

To support an understanding of the Offeror’s safety approach, the Offeror is encouraged to provide available safety performance indicators, such as Experience Modification Rates (EMR) for the most recent three years, where applicable to the business unit(s) performing the Work. If provided, any EMR exceeding 1.0 should be accompanied by a brief explanation.

Disclosure of regulatory citations (including OSHA, Cal-OSHA, or equivalent international safety authorities) within the past three years is requested only to the extent such information is readily available and deemed relevant by the Offeror. Where disclosed, a high-level summary of the nature of the citation and its resolution status is sufficient. Detailed reporting is not required.

Failure to provide the above information will not, in itself, render a proposal non-responsive. However, the Laboratory reserves the right to request additional clarification if necessary to evaluate the Offeror’s ability to perform the Work in a safe and responsible manner.

Note: The Offeror may amend the format for Attachment A, as long as the exact information, font and size and page limitations are followed.