ATTACHMENT_J-12_Past_Performance_Report_Short_Form.pdf

!\TTJ\CIIMENT

A TTr\CIIMF.NT - PAST PERFORMANCE INFORMATION

CONTRACTOR PERFORMANCE REPORT - SllORT FORM

PART I: Co111rac1 l11for111nlio11 (to be completed by Offcror)

l. Name of Conlracting Entity:

2.Contrnct Numb..:r:

}. Contract Type:

·l.Contracl V:lluc (TEC): (ii' subconlracl. subconlract value)

5. IJcscription of Work/Services:

6. Prohlcm: (if problems cncountcrcd on this con1ract, explain corrective nction taken)

7. Contucls: (~amc. Tdcpltone Number ~n<l E-mnil ud<lrcss)

7a. Contracting Oniccr:

Phone Number:

Em;iil Address:

7b. Technical Onicer(CTO):

Phom: Numb.:r:

Email AdJrcss:

7c. Other:

S. Offcror:

19. Information l'rovid;!d in Response to RFP No.: