Sec L Attachment E - Past Performance Info Form (PPIF) (Amd 0001).pdf

Request for Proposal No. 89233220RNA000002

Section L, Attachment E, Page 1

SECTION L

ATTACHMENT E

PAST PERFORMANCE INFORMATION FORM

1. Complete Name of Offeror, and Parent Organization/Team Member Name, if applicable

1a. DUNS Number 1b. CAGE Code

2. Contract Title and Performance Location

3. Customer Name, Current Address, Telephone Number and E-mail

4. Contract Number and Type of Contract 5. Date of Contract Award

6. Date Work Commenced 7. Date the Work was Completed

8. Initial Contract Price /Estimated Cost and Fee 9. Final Amount Invoiced/Amount Invoiced to Date

10a. Technical Point of Contact (see instruction below) 10b. Contracting Point of Contact (see instruction below)

11a. Activity Title (if different from Contract Title) 11b. If the Contract received a qualified, disclaimer, or adverse audit opinion over the past five years, so note. Provide a copy of the auditor’s report

(financial audits only).

12a. Proposed SOW Task Area(s) to be performed (Offerors may also explain how the past work relates to the scope of work proposed for the team member, include Chapter and Section # from Statement of Work):

12b. Affiliation (If the past performance of an affiliate is presented for consideration under this RFP, the Offeror shall describe the relationship between the affiliate and the Offeror’s team, if applicable. The Offeror shall also describe how the resources of the affiliate will be brought to bear in contract performance. The Offeror may provide any additional information to demonstrate a nexus between the past performance of the affiliate and contract performance.):

12c. Description of Work:

Section L, Attachment E, Page 2

13. Self-Assessment of Past Performance Record. (Provide information on any problems encountered or adverse past performance information and your corrective actions.)

If more space is needed, please attach additional pages.

14. Current Status of Contract (Choose One)

[ ] Work Continuing, on Schedule [ ] Work Continuing, Behind Schedule [ ] Work Complete, Litigation Pending or Underway

[ ] Work Completed, No Further Action Pending or Underway [ ] Work Completed, Routine Administrative Action Pending or Underway [ ] Work Completed, Claims Negotiations Pending or Underway [ ] Terminated for Convenience

[ ] Terminated for Default [ ] Other (explain)

Section L, Attachment E, Page 3

Instructions for Completing the Past-Performance Information Form

Submit no more than three Past-Performance Information Forms (Form) for each proposed team member. Only one Contract shall be described per Form. Contracts listed may include federal, state, and local Government and commercial customers. The experience cited must be within the last five years and at least nine months in duration.

Item 1. Insert the name of the Offeror, and parent organization/team member or subcontractor, if applicable. Do not use acronyms.

Item 1a. Insert DUNS number of Contractor performing contract/project listed on PPIF.

Item 1b. Insert CAGE Code of Contractor performing contract/project listed on PPIF.

Item 2. Insert the contract title and address where work was performed. Do not use acronyms.

Item 3. Insert customer’s name, current address, including both post office box and street address (if applicable), telephone number, and e-mail.

Item 4. Insert any contract number, or other contract reference used by the customer, and the type of contract.

Item 5. Insert the date on which the contract was awarded.

Item 6. Insert the date on which work began.

Item 7. Insert the date on which the customer agreed that the work was satisfactorily completed (including substantial completion), aside from any pending or ongoing administrative actions, claims, negotiations, or litigation.

Item 8. Insert the initial contract price/estimated cost and fee, or target cost and profit or fee as it appeared in the original contract. If the contract included multiple, separately-priced items, add the individual item amounts and insert the total price, estimated cost and fee, or target cost and profit or fee.

Item 9. 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 10a. Insert the name, title, company/agency, address, telephone 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.

Item 10b. Insert the name, title, company/agency, address, telephone number, and e-mail 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.

Section L, Attachment E, Page 4

Item 11a. Provide the Activity Title.

Item 11b. Identify if the contract received a qualified, disclaimer, or adverse audit opinion over the past five years. Provide a copy of the auditor’s report (financial audits only).

Item 12a. List the Statement of Work task areas in Section J, Appendix A, Statement of Work that you will perform under the Contract.

Item 12b. If the Offeror submits an affiliate’s contract or project as a reference, the Offeror shall describe the relationship between the affiliate and the Offeror’s team, if applicable. The Offeror shall also describe how the resources of the affiliate will be brought to bear in contract performance under the Y-12 National Security Complex

(Y-12) in Oak Ridge, TN and the Pantex Plant (PX) near Amarillo, TX Management and Operating (M&O) Contract. The Offeror may provide any additional information to demonstrate a nexus between the past performance of the affiliate and contract performance.

Item 12c. Describe the nature and scope of the work as it relates to your proposed role in performing Section J, Appendix A, Statement of Work . The objective is for you to explain how the work you performed or are performing, is relevant (similar in scope, size in dollars, and complexity) to the Statement of Work (SOW) that is to be performed by you under the Contract. Provide a crosswalk to the SOW elements that are relevant to the work described in each Form. It is the Offeror’s responsibility to provide adequate information to enable the Government to obtain completed Past

Performance Questionnaires from all referenced companies.

Item 13. Describe any unusual circumstances of performance or problems that may be relevant to the work that is to be performed and how those problems were addressed. Also describe any regulatory fines or Notices of Violation, if applicable. Tell your side of the story of any conflicts with the customer concerning adverse remarks about your performance. Describe any actions that you have taken or plan to take to correct any shortcomings in your performance. In addition, include a list of all small business subcontracting plan goals that were not met for any reason (partially or completely) and reason for the failure to meet the goals.

Item 14. Check appropriate box.