SA03 - FSLT - Past Performance Reference Information Sheet.pdf

N3220524R4004

SOURCE SELECTION INFORMATION — SEE FAR 2.101 & 3.104

ATTACHMENT 3

PAST PERFORMANCE REFERENCE INFORMATION SHEET

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

2. Complete Address of Reference

3. Contract Number or other control number 4. ☐ Prime

☐ Sub-Contractor

5. Date work was begun 6. Date work was completed

7. Contract type, initial contract price, estimated cost and fee, or target cost and profit or fee

8. Final amount invoiced or amount invoiced to date

9a. Reference/Technical point of contact (name, title, address, telephone no. and email address)

9b. Reference/Contracting point of contact (name, title, address, telephone no. and email address)

10. Location of work (country, state or province, county, city)

11. Current status of contract (choose one):

[ ] Ongoing

[ ] Complete

[ ] Terminated for Convenience

[ ] Terminated for Default

[ ] Other (explain)

N3220524R4004

SOURCE SELECTION INFORMATION — SEE FAR 2.101 & 3.104

12. Provide a summary description of contract work. Describe the scope and complexity of work, its relevancy to the efforts to be performed under this solicitation, and a description of any problems encountered and your corrective actions. Additional details, to include past performance information regarding predecessor companies, key personnel who have relevant experience and subcontractors that will perform major or critical aspects of the requirement can be attached to this form, but shall not exceed two (2) pages in length.

13a. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes __, No__.

13b. If “Yes” to 13a, have you regularly submitted your reports in the Electronic Subcontract Reporting System (ESRS) in a timely manner? Yes __, No__.

If no, why not?

14. Required for all offerors (Large and Small Businesses):

Address historical compliance with the requirements of FAR Part 52.219-8 (Utilization of Small Business Concerns) for government contracts, to include timely payment of amounts due pursuant to the terms of their subcontracts with small business concerns, veteran-owned small business concerns, service-disabled veteran-owned small business concerns, HUBZone small business concerns, small disadvantaged business concerns, and women-owned small business concerns.

Our company ☐ HAS ☐ HAS NOT historically complied with the requirements of FAR Part 52.219-8 (Utilization of Small Business Concerns) for government contracts.