4.04 Attachment 9 Contractor Data Sheet.doc

N00244-16-R-0055

OFFEROR'S PAST PERFORMANCE DATA

COMPANY NAME:

ADDRESS:

CONTACT NAME:

TELEPHONE:

TELEFAX:

1. This Performance Data is to be used to evaluate your Company's past performance in meeting contract cost/price, technical, and delivery objectives.

2. List Performance Data on your three most recently completed Federal Government contracts (not to exceed three years since completion) for like or similar items required by this solicitation. If you do not have three Federal Government contracts, then list state, local, or commercial contracts, in that order, to complete this report.

Please confirm that the information, to include the contact information, is up-to-date, before returning this form. Failure to return the requisite documentation, properly completed, may result in a less-than-acceptable past performance valuation.

3. CONTRACT NUMBER FOR REFERENCE #__

a. AWARDED BY: (Command or PCO) (Contracting Officer), Date Awarded:

b. ADDRESS:

c. CITY/STATE/ZIP:

d. CONTACT NAME: (Contracting Officer Technical Representative, Other End-User or Customer Representative with knowledge about contractor performance):

e. TELEPHONE/FAX:

f. CONTRACT TYPE:

g. ITEM DESCRIPTION:

h. CONTRACT DOLLAR VALUE:

i. Yes* No Was consideration or a monetary withhold assessed against this contract for non-conforming supplies/services? or failure to meet a K requirement?

j. Yes* No Was, or is, any part of this contract terminated for default at no cost or involved in litigation?

k. Yes* No Was any warranty work completed on delivered items?

l. Yes No* Were all items delivered within the original contract schedule?

m. Yes* No Has your Company received any quality awards in the past three years?

n. For all answers with an asterisk, please provide an explanation. Describe any corrective actions initiated to solve any of the above-described problems/deficiencies on this contract. Discuss the success of the corrective actions taken.