D_-_PPPF.pdf

ATTACHMENT D

October 2015 Version

Federal Protective Service Cybersecurity and Infrastructure Security Agency

Western Consolidated Contracting Group

400 15th St. SW Auburn, WA 98001

PAST PERFORMANCE PROJECT FORM

Instructions for Completing the Past Project Form

The Contractor is allowed to submit up to a maximum of three (3) past performances from the last three (3) years.

Please fill out one (1) form per each past performance submitted. The Contract shall submit a total of three (3) forms, if they chose to submit the maximum allowed.

Item1 Insert Name of Offeror Item 2 Insert Solicitation Number Item 3 Insert the complete name of the customer, including parent organization. Do not use acronyms.

Item 4 Insert the customer's complete address, including both post office box and street address, if possible.

Item 5 Insert any contract number or other contract reference used by the customer.

Item 6 Insert the date on which the contract came into existence.

Item 7 Insert the price of the total project.

Item 8 Insert the period of performance.

Item 9 Annotate whether or not a clearance was required. If applicable, insert the type clearance, i.e. Top

Secret, Secret) Item 10 Insert the name, title, address, telephone number, and email address (if available) of the contracting officer, purchasing agent, or other customer contracting or purchasing representative who is most familiar with your work under the contract.

Item 11 Insert the location(s) where the work was performed, including the country (if other than the United States) and the state or province, county (if applicable), and city.

Item 12 Describe the nature and scope of the work. 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 contemplated by the request for proposal. Describe any unique or unusual requirements of the contract and any problems encountered during the performance of this contract work. 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.

1. Name of Contractor

2. Solicitation Number (i.e. the solicitation your firm is responding to):

3. Complete Name of Government Agency, Commercial Firm, or other Organization for which effort performed.:

4. Complete Address of Entity Named in #2 Above:

5. Contract Number or Other Reference:

6. Date of Project Award:

7. Total Project Price:

8. Period of Performance:

9. Level of Security Clearance Required (If applicable)

(If applicable) Type/Level:

10. Contracting or Purchasing Point of Contact (name, title, address, telephone no., and email address):

11. Geographic Location of Work (Country, State or Province, County, City):

12. Description of Contract Work. In order to establish the relevance of your project to the instant requirement, please describe the scope, magnitude and complexity of this work, comparing and contrasting it to that required under this solicitation. Additionally, describe any unique or unusual requirements of the contract, and performance problems or issues encountered under the performance of the contract. Include discussion of any previous or ongoing Department of Labor investigations of your firm for Service Contract Act or other labor related violations.

For problems/issues noted, describe the method of resolution and/or corrective actions taken. Use a continuation sheet, if necessary.