1625DC-19-Q-00021_Attachment_J.L.1.pdf

1625DC-19-Q-00021 Attachment J.L.1

RFQ ATTACHMENT 1

PAST PERFORMANCE INFORMATION SHEET (PPIS)

PAST PERFORMANCE INFORMATION SHEET (PPIS)

Provide the information requested in this form for each Past Performance Reference as required by L.8.

Provide frank, concise comments regarding performance on the reference you identify. Provide a separate completed form for each reference submitted. Submit the forms as part of Volume 2: Past Performance.

A. Offeror Name (Company/Division):

*Please identify if you are a teaming member or subcontractor with the prime

Cage Code:

DUNS Number:

(NOTE: If the company or division performing this effort is different than the offeror or the relevance of this effort to the instant acquisition is impacted by any company/corporate organizational change, note those changes below. Refer to the "Organizational Structure Change History" you provided as part of your Past Performance Volume).

B. Program Title:

C. Contract Specifics:

1. Contracting Agency or Customer:

2. Citation Number:

3. Contract Type:

4. Period of Performance:

5. Original Contract $ Value (Do not include unexercised options):

6. Current Contract $ Value (Do not include unexercised options):

7. If the amounts for 5 and 6 above are different, provide a brief description of the reason below.

8. Original completion date:

9. Current scheduled completion date:

10. Estimated completion date:

11. Number of contract changes:

12. Enter primary cause for contract changes below:

D. Enter below a brief description of effort as Prime or Subcontractor.

E. Primary customer points of contact. (For Government contracts/orders, provide current information on all three individuals. For commercial contracts, provide points of contact fulfilling these same roles.)

1. Program Manager and/or Site Manager

2. Procurement Contracting Officer

3. Administrative Contracting Officer

Name

Office

Address

Telephone

FAX #

E-Mail

F. Address below any technical (or other) area about this citation considered unique.

G. Describe the relevancy to the Factor 1: Technical Capability for which this citation applies.

Illustrate how your experience on this program applies to that factor. Include labor categories that were used to perform the contract deliverables.

H. Subcontracting Plan Requirements.

1. Was a subcontracting plan required? If YES, go to # 2. If NO, skip this section.

2. Planned goal (%) Achieved goal (%)

3. Explain below why goals were not met.

RFQ ATTACHMENT 1