APPENDIX N Applications Prep Instructions Past Performance Information Template (applicable to Demos, Risk Reduction, ARC-20).pdf

Funding Opportunity Announcement Number: DE-FOA-0002271

APPENDIX N

APPLICATION INSTRUCTIONS – PAST PERFORMANCE INFORMATION TEMPLATE

(applicable to Demos, Risk Reduction, ARC-20)

1. Complete name of Government agency, commercial firm, or other organization

2. Complete address

3. Contract/financial assistance number or other reference and type 4. Date of contract/financial assistance

5. Date work commenced 6. Date work was completed or scheduled to be completed

7. Contract/financial assistance Type and Contract/financial assistance Value 8. Final amount invoiced, or amount invoiced to date

9a. Technical point of contact (name, title, company/agency, address, telephone number, fax number, and e-mail address)

9b. Contract/financial assistance point of contact (name, title, company/agency, address, telephone number, fax number, and e-mail address)

9c. Environmental Regulator point of contact (name, title, company/agency, address, telephone number, fax number, and e-mail address)

10. Consultants and partners/subcontract/financial assistance used (names, addresses, and phone numbers)

11. Project/Contract/Financial Assistance Title

12. Description of contract/financial assistance work (Describe nature and scope)

13. Current Status of Contract/financial assistance (choose one)

[ ] Work Continuing, On Schedule

[ ] Work Continuing, Behind Schedule

[ ] Work Completed, No further Action Pending or Underway

[ ] Work Completed, Routine Administrative Action Pending or Underway

[ ] Work Completed, Litigation Pending or Underway

[ ] Terminated for Convenience

[ ] Terminated for Default

[ ] Other (explain):

Attach additional sheet if necessary (one additional sheet maximum)

Instructions for Completing the Reference Information Worksheet

Item 1. Insert the complete name and address of the customer, including parent organization, if any.

Do not use acronyms.

Item 2. Insert the customer’s complete address, including both post office box and street address, if applicable.

Item 3. Insert any contract/financial assistance number or other contract/financial assistance reference used by the customer and contract/financial assistance type.

Item 4. Insert the date on which the contract/financial assistance came into existence.

Item 5. Insert the date on which you started to perform the work.

Item 6. Insert the date on which the customer agreed that the work was satisfactorily completed (including substantial completion), aside from any pending or on-going administrative actions, claims negotiations, or litigation.

Item 7. Insert the contract/financial assistance type and contract/financial assistance value (separately listing fee if cost-type).

Item 8. Insert the final sum of all invoices, or the sum of all invoices to date, including agreed upon and disputed amounts, paid and awaiting payment.

Item 9a. Insert the name, title, company/agency, address, telephone number, facsimile number, and e-mail address (if available) of the program or project manager, quality assurance representative, or other customer technical representative who is most familiar with the quality of your work under the contract/financial assistance.

Item 9b. Insert the name, title, company/agency, address, telephone number, facsimile number, and e-mail address (if available) of the contract/financial assistance officer, purchasing agent, or other customer contract/financial assistance or purchasing representative who is most familiar with your work under the contract/financial assistance.

Item 9c. Insert the name, title, company/agency, address, telephone number, facsimile number, and e-mail address (if available) of (a) lead environmental regulator(s) or a State regulatory office director under whose authority environmental regulations would be enforced.

Item 10. Insert names and phone numbers of consultants and partners/subcontract/financial assistance used.

Item 11. Insert the title of the project and/or contract/financial assistance.

Item 12. Describe the nature and scope of the work. Describe the relevance of the work to the current acquisition and discuss performance. The objective is to show how the work that you did or are doing is similar in nature and scope to the work that is to be performed under the contract/financial assistance contemplated by the request for proposals. Describe any unusual circumstances of performance or problems that may be relevant to the work that is to be performed. Tell your side of the story of any conflicts with the customer concerning which they may make adverse remarks about your performance. Describe any actions that you have taken or plan to take to correct any shortcomings in your performance.

Item 13 Check the box which most accurately describes the current contract/financial assistance status.