Attachment_4_Past_Performance_Risk_Reference_Sheet_6_Jan_2016.pdf

W58RGZ-15-R-0166

Attachment 0004

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:

Point of Contact knowledgeable about the Program: **Please validate telephone numbers and 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)