Past Performance Questionnaire - - Vendor Name

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PAST PERFORMANCE QUESTIONNAIRE

This questionnaire requests information about work your company has previously performed. Please complete Sections 1 through 4, then forward the form to your reference (the customer for whom the work was performed) to complete the remaining sections.

1. CONTRACTOR / OFFEROR INFORMATION

Past Performance Reference No. (1-3): Click or tap here to enter text. Offeror Name: Click or tap here to enter text.
Address: Click or tap here to enter text.
Phone Number: Click or tap here to enter text.
SAM UEI (Unique Entity ID, from SAM.gov): Click or tap here to enter text. Contact Name: Click or tap here to enter text.
Email Address: Click or tap here to enter text.
Contact Phone Number: Click or tap here to enter text.

2. GENERAL WORK INFORMATION

Work performed as: ☐ Offering Entity (Prime Contractor) ☐ Predecessor Company ☐ Key Personnel Percent (%) of project work performed by the Offering Entity (Prime Contractor), Predecessor Company, or Key Personnel: Click or tap here to enter text. List of Major Subcontractor(s) and Role(s): Click or tap here to enter text.

3. CONTRACT INFORMATION

Contract Number: Click or tap here to enter text.
Contractor Name as Reflected on the Referenced Contract: Click or tap here to enter text. Contractor SAM UEI as Reflected on the Referenced Contract: Click or tap here to enter text. Agency/Customer: Click or tap here to enter text.
Delivery/Task Order Number (if applicable): Click or tap here to enter text. Contract Type: ☐ Firm Fixed Price ☐ Cost Reimbursement ☐ Other (please explain) Contract Title: Click or tap here to enter text.
Contract Location: Click or tap here to enter text.
Award Date (mm/dd/yy): Click or tap here to enter text. Completion Date (mm/dd/yy): Click or tap here to enter text. Awardee Ongoing Services: Click or tap here to enter text. Original Contract Price (Award Amount): Click or tap here to enter text. Final Contract Price (to include all modifications, if applicable): Click or tap here to enter text.

REFERENCE INFORMATION

Please provide contact information for up to three individuals who can speak to the performance described in this questionnaire. Past Performance Questionnaire Reference
Name & Title:
Click or tap here to enter text.
Phone No.:
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Email:
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Address:
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Contracting Officer (CO), or Individual Responsible for Signing the Contract