Name of the Company: ______________________________________________________________

Address: ______________________________________________________________________________

STATEMENT OF SINGLE LARGEST COMPLETED CONTRACT

a. Name of the Contract a. Date of Contract a. Kinds of Goods/Nature a. Date of completion or

of Works delivery
b. Name of the Procuring b. Contract
Entity Duration (No. of b. Contract Amount or
days or months) value/Adjusted
Contract amount, if
applicable
a. a. a. a.
b. b. b.

This statement shall be supported by:

1. Notice of Award;
2. Contract;
3. Notice to Proceed; and
4. Certificate of Completion and Final Acceptance.

Submitted by:

NAME OF THE BIDDER OR ITS AUTHORIZED REPRESENTATIVE AND ITS SIGNATURE

Designation