Past_Performance_Profile3.doc

Attachment B – Past Performance Profile Submitted as part of the Technical Quote in response to RFQ: SAQMMA16R0165a Submitted by:

Company:

POC Name:

Company DUNS number:

Phone:

Email:

Past Performance Contract Number: ____________________ Date of Award: mm/dd/yyyy

Performed as: FORMCHECKBOX Prime FORMCHECKBOX Subcontractor

Buyer Supported

Name:_____________________________________________________

FORMCHECKBOX

Federal Agency FORMCHECKBOX Private Sector Business

Buyer Points of Contact

Contract Signer:

Name:

Address:

Telephone Number: Email Address:

COR/COTR or Performance Supervisor:

Name:

Address:

Telephone Number: Email Address:

Project Location(s) [State or Country]:

Actual Contract Dollars (not Contract Ceiling Value):

Type of Award: FORMCHECKBOX Competitive FORMCHECKBOX Sole Source

Contract Vehicle: FORMCHECKBOX GSA Schedule FORMCHECKBOX

NASA SEWP IV FORMCHECKBOX

Open Market

FORMCHECKBOX

Other (explain):

Contract Type (Firm Fixed Price, Time and Materials, Cost Plus, etc.):

Descriptions of Items Delivered, including associated services, quantities, timelines:

Technical, Cost or Schedule Problems Encountered and Resolution:

Innovative Solution Applied, Cost-Savings Realized or Recognition Received: