Attachment 22- FACTS Sheet Word Format.docx

Attachment 22: FACTS Sheet FA664323R0005 2 August 2023 Section 1: Contract Identification

A. Contractor (Company/Division): ______________________________________________________ B. Contractor Cage Code: ______________________________________________________________ C. Contract Number: _________________________________________________________________ D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.): __________________________________________ E. Program Title: ____________________________________________ F. Brief Program Description: _________________________________________________________ G. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

H. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $ ________________

2. Current maximum contract dollar value (assuming all options exercised): $ _________________

3. Reasons for difference between original and current contract dollar value (if applicable):

I. Description of work performed, to include how that work is relevant to the work of this acquisition:

J. If problems were encountered during the performance of the work, describe actions taken to isolate the root causes of problems and resolve those causes.

K. Which of the following did this work apply to? ☐ Material Management ☐ Ground Transportation/Vehicle Management ☐ Traffic Management ☐ Real Property Maintenance ☐ Fuels Management

L. How many FTEs are provided on this contract/task order: __________________________________ M. Was this a competitively awarded contract? ☐ Yes ☐ No N. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel ☐ Other (Please specify): __________________________________________

Section 2: Customer or Agency Identification

A. Customer or agency name: __________________________________________________________ B. Customer or agency description (if applicable): __________________________________________ C. Customer Type: ☐ Federal government ☐ State or local government ☐ Commercial D. Geographic description of services under this contract (i.e., local, nationwide, worldwide):

Section 3: Respondent Identification

A. Respondent’s name: ________________________________________________________________ B. Respondent’s title: _________________________________________________________________ C. Respondent’s phone number / e-mail address:

D. Respondent’s position:

☐ Procuring Contracting Officer or equivalent ☐ Program/Project Manager or equivalent ☐ Administrative Contracting Officer or equivalent ☐ Other (specify):

E. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

F. Other suggested points of contact:

ADDITIONAL NOTES: Ensure to identify the section prior to adding additional information (e.g.

Section 1J or Section 1 Item J).