Attachment_3-Past_Performance_Information_Form.pdf

SOLICITATION: 1305M2-19-Q-NFFM-0274

ATTACHMENT: 3

PAST PERFORMANCE INFORMATION FORM FORM ________ of _________

VENDOR NAME:

CONTRACT and ORDER NUMBER: AGENCY or CLIENT (name and location):

1. Refer to FAR Clause 52.212-1 Instructions to Offeror of Solicitation 1305M2-19-Q-NFFM-0274. The vendor shall complete this form in its entirety for each contract identified in the vendor’s Volume II , Factor II– Past Performance.

2. Check one of the following statements:

CPARS - The referenced Contract Number has a completed CPAR and can be located in the Past

Performance Information Retrieval System (PPIRS).

Past Performance Questionnaire (Fill-in Data under item 3 prior to sending to Agency/Client POC)

_______ The Point of Contact or Project Manager associated with the work completed under the referenced Contract Number has been sent this form and the Past Performance Questionnaire to complete and return to Contract Specialist, Samantha Alb prior to the closing date of the solicitation: Friday, August 16, 2019

12:00 PM EST.

EMAIL: Samantha.Alb@noaa.gov

3. Provide the following data in its entirety.

a. Client point of contact (including 2 points of contact with telephone numbers)

POC #1: ________________/Title: _____________/ Phone: _____________/ Email: _______________ POC #1: ________________/Title: _____________/ Phone: _____________/ Email: _______________

b. Brief Description of Project (Identify how the project relations to this solicitation):

c. Dollar Value of the contract (Original: $ _______________and Final: $_________________)

d. Whether Prime or Sub Contractor: and type of services performed:

Prime or Sub: _________ Type: _______________

e. Contract performance period: Start: _____________ End: __________________

f. Actual performance dates upon completion: Begun: ________________ Completed: __________________

g. Contract Type: _______________ mailto:Samantha.Alb@noaa.gov

h. Percentage of growth in contract price (Additional work divided by award price) and the extent of Subcontracting:

Growth Percentage: __________% Extent of Subcontracting: ___________________________

NOTE: It is the responsibility of the Vendor to follow‐up and to encourage references to submit the questionnaire prior to the solicitation closing date of: Friday, August 16, 2019 at 12:00 PM EST.