J.2_Past_Performance_Template.docx

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HIV Regional Flagship Activity
Solicitation number
SOL_176_15_000001
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J.2 Past Performance Template

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ATTACHMENT 2 - PAST PERFORMANCE QUESTIONNAIRE

REQUEST FOR PROPOSALS No.: 176-15-000001

Please fill out the following questionnaire as clearly and as objectively as possible. The information you provide will be used for source selection purposes. Please send the filled out questionnaire directly to the United States Agency for International Development (USAID) in the Central Asian Republics by email at ., not later than January 12, 2015, 2:00pm Almaty Time.

SECTION A: (To be filled by the contractor)

Contractor's Name:

Was the Contractor the Prime or Subcontractor on the project:

Project Name:

Project Scope/Description:

Period of Performance: Dollar Value of Contract:

Name of Contact Person: _Phone:

Date Contacted: Employer:

Contact’s Role or Knowledge of the Project:

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