Statement of Single Largest Completed Contract (SLCC) Similar to the Contract to be Bid

Name of Contract:
Name of the Bidder:
Address of the Bidder:
Contact No.

End User's
Acceptance or
Official Receipt(s)
Amount of or Sales Invoice
Item Name of the Completed Date of the Contract Owner's Name & Address Completed shall be attached to
No. Contract Contract Duration (Telephone No., if available) Kinds of Goods Contract Date of Delivery the statement

Submitted by:

_______________________________
Printed Name and Signature