PSA-16-R-0012_-_Performance_Reference_-_Attachment_II.pdf

PSA-16-R-0012

ATTACHMENT II

PERFORMANCE REFERENCE

CONTRACTOR’S NAME: _________________________ CONTRACT NUMBER________________________

1. The Performance Reference Attachment and Past Performance Survey Attachment should be completed by the individual most knowledgeable of the Contractor’s day-to-day operations and overall condition of services being rendered. However, that individual is encouraged to supplement their own knowledge of the Contractor’s performance with the judgment of others in their organization, as applicable.

2. Handwritten responses are sufficient. Please make them legible. Only scanned e-copies must be provided, paper copies are not required and will not be accepted.

3. Please provide explanatory narratives for as many responses as possible. These narratives need not be lengthy, just descriptive. Space for narrative comments is included on the last page of the survey. If more space is needed, one additional page may be added.

4. Since the reference and survey relates to an ongoing source selection for the services identified in the solicitation, the Government request that all information provided within the survey be safeguarded against unauthorized disclosure.

5. The Offeror shall provide a maximum of three (3) references for services of comparable scope and complexity performed by the offeror within the past three (3) years.

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Address: __________________________

Telephone Number: ____________________ __________________________

Fax Number: ____________________ __________________________

Point of Contact: ____________________

Project Title or Brief Description of Work: ___________________________________________*

Contract Number Provided by Offeror: ____________________ Dollar Amount: $ _________*

Contract Period or Dates of Performance Provided by Offeror: __________________________*

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Company Name/Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. E-MAIL COMPLETED PAST PERFORMANCE REFERENCE AND PAST PERFORMANCE

SURVEY ATTACHMENT FORMS NO LATER THAN THE DUE DATE/TIME SPECIFIED IN

THE SOLICITATION TO THIS EMAIL ADDRESS: thomas.guziewicz@psa.gov mailto:thomas.guziewicz@psa.gov