70RTAC26R00000004 - Attachment 3.doc

70RTAC26R00000004

ATTACHMENT 3

PAST PERFORMANCE FORM

1. Name of Contractor

1a. Solicitation Number (i.e. the solicitation your firm is responding to)

2. Complete Name of Government Agency, Commercial Firm, or Other Organization for Which Effort Performed.

3. Complete Address of Entity Named in #2 Above

4. Contract Number or Other Reference

5. Date of Project Award

6a. Total Project Price (to include all options):

6b. Current Annual Estimated Price:

7. Period of Performance (to include all options)

8. Level of Security Clearance Required (If applicable)

(If applicable) Type/Level:

9. Number of hours (Level of Effort) Per Year:

10. Number of employees utilized to perform the required hours:

11a. Technical Point of Contact (name, title, address, telephone no., and email address)

11b. Contracting or Purchasing Point of Contact (name, title, address, telephone no., and email address)

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

13. Contractor Performance Assessment Reporting System (CPARS) Completion: CPARS is a web-enabled application that collects and manages contractor performance assessments. A CPAR report is required to be completed annually through the conclusion of the contract. Contractors may view their CPARs data http://www.SAM.gov/.

Contractor Complete the Following by Checking the Appropriate Box:

□ A “finalized” Contractor Performance Assessment Report IS resident in SAM.gov for this contract for the most recently completed performance period.

□ A “finalized” Contractor Performance Assessment Report IS NOT resident in SAM.gov for this contract for the most recently completed performance period..

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

15. Did this contract require the submission of a subcontracting plan? If so, describe the efforts being made to meet the subcontracting goals contained within the approved plan to include the name(s) of subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s).

Instructions for Completing the Past Performance Form

Item1 Insert Name of Offeror Item 1a Insert Solicitation Number

Item 2 Insert the complete name of the customer, including parent organization. Do not use acronyms.

Item 3 Insert the customer's complete address, including both post office box and street address, if possible.

Item 4 Insert any contract number or other contract reference used by the customer.

Item 5 Insert the date on which the contract came into existence.

Item 6 Insert the price, as it appeared in the original contract inclusive of all option periods. If the contract included multiple, separately-priced items, add the individual item amounts and insert the total price.

Item 6a Insert the current total annual amount Item 7 Insert the period of performance to include all option periods (if applicable).

Item 8 Annotate whether or not a clearance was required. If applicable, insert the type clearance, i.e. Top Secret, Secret) Item 9 Insert the number of productive hours under the contract on an annual basis.

Item 10 Insert the total number of employees to perform this effort

Item 11a Insert the name, title, address, telephone number, and email 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.

Item 11b 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 12 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. If contract requires protective security officer services at multiple locations, identify all locations.

Item 13 Indicate whether a “finalized” Contractor Performance Assessment Report is resident in SAM.gov by checking the appropriate box.

Item 14 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.

Item 15 Insert the name, address, telephone number, and email address (if available) of the subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s).