REFERENCE_INFORMATION_SHEET.docx

REFERENCE INFORMATION SHEET

Please fill out one for each reference provided in your proposal

1. Complete name of Government agency, commercial firm, or other organization

2. Complete Address

3. Contract Number or other reference

4. Date of Contract

5. Date work was started

6. Date work was completed

7. *Total Contract award amount to include base and all option periods

8a. Technical point of contact (name, title, address, telephone no. and email address)

8b. Contracting or purchasing point of contact (name, title, address, telephone no. and email address)

9. Location of work (country, state or providence, county, city)

10. Description of contract work (Describe complexity, number of tasks, scope, and type of work. Attach an explanation of any performance problems or other conflicts with the customer. Describe any litigation, pending, on-going, or completed. Use a continuation sheet, if necessary.)

11. Current status of contract (choose one):

Work continuing, on schedule Terminated for convenience

Work continuing, behind schedule Terminated for default Work complete, no further action pending or underway Other (explain)

Work completed, routine administrative action pending or underway Work completed, claims negotiations pending or underway

Work completed, litigation pending or underway

12. Part to be completed by Government:

Reference Favorable Reference Unfavorable

*If this information is available in Government databases, Contracting Office will verify and apply the correct amount for evaluation purposes.

W912CM-18-Q-0045