VA797W-17-R-0003-00001009.doc

VA797W-17-R-0003

Attachment I

PAST PERFORMANCE

Please provide the following information for each of your current and completed commercial and/or Federal Government contracts for the period 1/1/14 through 12/31/16 of comparable size, depth, breadth, relevancy and complexity to the requirements of this solicitation. This form may be duplicated.

Offeror: ___________________________________________

Number of years as a reverse distributor: ___________________

1. Customer Name and Address:

Customer Contact Person: _______________________ Telephone Number_________________

E-mail Address: _________________________________

2. Information About the Contract:

Contract Number: _____ ______ Contract Period: ____________________

Estimated Annual Returns Processed: __________________________

Estimated Annual Pounds of Destruction: ________________________

Number of locations serviced: _______________________

Description of Customer Contract Requirements/Scope/Services:

Note: VA reserves the right to verify information provided or to request additional information.