Attachment 2b Appendix B Work Sample Cover Sheet4May26

<<Input OFFEROR NAME>>

WORK SAMPLE COVER SHEET

PART I: WORK SAMPLE IDENTIFICATION

Contractor Name:

Contract Number:

Task Order Number (if applicable):

Subcontract Number (if applicable):

Customer:

Period of Performance:

Work Sample Value:

Work Sample Identifier (WS1, WS2, etc):

825534480500PART II: PROJECT DESCRIPTION (2 page limit)

Instructions to Appendix B – Work Sample Cover Sheet

DELETE THIS PAGE UPON COMPLETION OF THE WORK SAMPLE COVER SHEET

Offerors shall follow the instructions below when filling out Appendix B Work Sample Cover Sheet.

Please mark “Not Applicable” or “N/A” if requested data is not applicable to subject Work Sample.

PART I: WORK SAMPLE IDENTIFICATION

Contractor Name: Offerors shall enter the Contractor’s Name of this work sample. Contract Number: Offerors shall enter the Contract Number. Task Order Number: Offerors shall enter the Task Order Number (if applicable). Subcontract Number: Offerors shall enter the Subcontract Number (if applicable). Customer: Offerors shall enter the agency, organization, or client name. If the customer was a Government agency, or organization, Offerors shall include the office symbol and program name this work sample supports. Period of Performance: Offerors shall include the period of performance if the contract/order including all options. Offerors shall list the period of performance in the following format (MM/YYYY – MM/YYYY or MM/YYYY – Present): Work Sample Value: Offerors shall enter the final or most recent total contract/order value of the work sample. The total value shall include the value of all options. Work Sample Identifier: Works samples shall be numbered WS1-WS10. Insert the applicable work sample number.

PART II: WORK SAMPLE DESCRIPTION (2 page Limit)

Offerors shall provide a brief description of the work sample. If the Offeror uses a subsidiary or legal entity work sample as a prime work sample, the Offeror may use this section to further describe the relationship identified in Appendix B.