RRB12R004 FMIS RFP Attachment 4 Past Performance References updated 6-14-12.doc

CONTRACTOR PAST PERFORMANCE REFERENCES

Instructions: Please complete the following form for a minimum of three to a maximum of five references.

1. Complete Name of Reference (Government agency, commercial firm, or other organization)

2. Complete Mailing Address, Phone Number and E-mail Address of Reference

3. Name of contracting activity

4. Contract number or control number

5. Date of contract

8. Contract type, initial contract price, total contract value, estimated cost and fee, or target cost and profit or fee

9. Final amount invoiced or amount invoiced to date

10a. Reference/Technical point of contact (Name, Title, address, telephone number and email address)

10b. Reference/Contract Officer (if applicable) (Name, Title, address, telephone number and email address)

10c. Reference/Program Manager (Name, Title, address, telephone number and email address)

10d. Reference/Administrative Contracting Officer (if applicable) (Name, Title, address, telephone number and email address)

11. List of major subcontractors

12. Location of work (County, state or province, county, city)

13. Current status of contract (choose one)

· Ongoing

· Complete

· Terminated for Convenience

· Terminated for Default

· Other (Explain)

14. Provide a brief description of the contract and the relevancy of the effort to be performed in accordance with the SOW and requirements of the solicitation. Provide an estimated % of relevancy of the referenced contract to the requirements set forth in this solicitation. Relevance can be discussed in further detail on the attached summary description as set forth in block 16 below.

15a. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes _____ No ____

15b. If “Yes” to 15a, have you regularly submitted SF 294/295 reports on time? Yes _____ No ____

15c. Attach a copy of your most recently submitted SF294.

16. Provide a summary description of contract work, not to exceed two pages in length. Describe the nature and scope of work, its relevancy to this contract, and a description of any problems encountered and your corrective actions. Attach the explanation to this form.

U.S. Railroad Retirement Board RRB12R004 FMIS Attachment 4