18R0402_Attach_3_Past_Perf_Sample.pdf

Solicitation SP060418R0402

SOURCE SELECTION INFORMATION – See FAR 2.101 and 3.104

Attachment 3

Past Performance Form - SAMPLE (not more than 4 pages per form)

Project Title/Organization Managing Project:

Client Organization Point of Contact with address, current Telephone Number and Email address (Cite Project Reference Number)

Name: John Q. Smith Telephone Number: 703 123 4567 Email address: john.q.smith@federalagency.gov

Contract Number: GS 000 00000 Period of Performance (as awarded): March 1, 2005-April 30, 2008 Place of Performance – contractor’s facility, city, state Value by year of contract (as awarded): $150,000 for 12 months Role (Prime Contractor or Sub-contractor):

Initial Price as awarded vs. Final price at completion. (If the final price at completion exceeds the initial price as awarded, provide an explanation)

Initial Price as awarded: $150,000 Final Price at completion: $155,000

An increase to the contract occurred because it became necessary for long distance travel to conduct a site survey. The place originally selected for the site survey required only local travel.

That site was destroyed during a tornado. The client identified another suitable site which required Long Distance Travel

Contract Type (IDIQ, MAS, FSS Schedule, etc.): FSS Schedule 874V

Pricing Model (T&M, FFP, etc.)

FFP for Labor, FFP for hosting services; Cost Reimbursable for Long Distance Travel

A brief description of the project objectives:

The objective of this project was to

Offeror’s actual work performed and a description of its role in project, to include indication as either a prime or sub.

Discuss relevance of project to this RFQ and similarity to the objectives and requirements of this Contract

Solicitation SP060418R0402

SOURCE SELECTION INFORMATION – See FAR 2.101 and 3.104

Actual work performed:

Actual work performed:

Specify relevance:

Specify relevance: