Attach__6_-_PastPerformanceQuestionnairen.pdf

Past Performance Questionnaire

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NAME OF THE CLIENT (CONTRACTING PARTY)

CLIENT ADDRESS

CLIENT TELEPHONE NUMBER

CLIENT POINT OF CONTACT

CONTRACT NUMBER

TYPE OF CONTRACT( * 1)

NAME OF THE CONTRACT OR PROJECT

PROJECT LOCATION

PROJECT STARTING DATE

PROJECT FINISH DATE

WAS THE PROJECT FINISHED ON TIME ( Explain if needed)

SQUARE METERS OR UNITS (Indicate unit measurements)

CONTRACT COST IN PESOS

CONTRACT COST IN MONTHLY MINIMUM SALARIES

INDICATE IF IN THIS PROJECT YOU WERE THE PRIME

CONTRACTOR , SUBCONTRACTOR OR ASSOCIATE

INDICATE THE PERCENTAGE OF PARTICIPATION OF

YOUR FIRM IN THIS PROJECT

BRIEF DESCRIPTION OF ACTIVITIES BEING

PERFORMED

COMPARISON OF THE WORK PERFORMED WITH THIS

SOLICITATION ( *2 )

BRIEF DESCRIPTION OF TECHNICAL PROBLEMS

ENCOUNTERED AND THE WAY THEY WERE SOLVED

METHOD OF ACQUISITION (Public solicitation, private or non competed) award criteria

COST/PRICE MANAGEMENT HISTORY (any cost overruns and under runs, and cost growth and changes)

HAVE YOU HAD ANY CONTRACT TERMINATIONS IN

THE LAST FOUR (4) YEARS?

REASONS FOR TERMINATIONS (for contractor convenience, for default or other)

I certify that the information is accurate and verifiable

Signature of the Legal Representative Date Name of the Legal Representative Id Number

Artículo 289 del Código Penal Colombiano: “El que falsifique documento privado que pueda servir de prueba, incurrirá, si lo usa, en prisión de uno (1) a seis (6) años .”

(*2) En here you should indicate which activities performed are similar to the work being contracted.

Indicate the experience of the firm in similar projects performed in the last four (4) years. Include maximum 10 projects. Do not include certifications or contract copies. In the case we needed we will require it afterwards.

(*1)Consulting, construction, design, work oversight, delegated administration If you are not a company explain if you were the superintendent, director or other.

"FIRM EXPERIENCE"