Attachment_4_Past_Performance_Risk_Reference_Sheet_6_Jan_2016.doc

W58RGZ-15-R-XXXX

Attachment X

Past Performance Risk Reference Sheet

Offerors are to complete this portion of the attachment once for each reference that has been sent a questionnaire and submit with its Volume 3 – Past Performance submission. References are required for the Prime and for all Subcontractors.

Date prepared:

Date Past Performance Risk Assessment Questionnaire e-mailed to POC

Offeror’s Corporate Name:

Point of Contact:

Contracting Officer (If applicable)

Address:

City, State, Zip

Phone:

FAX:

References:

Government Organization or Company Name:

Division:

Program or Project Name:

Contract Number:

Contract Type (if applicable):

Program or Contract value:

Program Period of Performance:

Brief Description of the Work:

Why this Program was selected as a reference:

e-mail addresses prior to submittal**

Name:

Title:

Email Address

Mailing Address:

City, State, Zip:

Phone:

FAX:

Alternate Point of Contact knowledgeable about the Program.

Name:

Title:

Email Address

Mailing Address:

City, State, Zip

Phone:

FAX:

Reason for Contract Ending (Work Complete, if terminated prior to completion specify reason)

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