Attachment_3_-_Past_Performance_Information_Sheet.docx

Attachment 3 – Past Performance Information Sheet 140D0423R0001

PAST PERFORMANCE REFERENCE

INFORMATION FORM

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

2. Complete address

10. Location of work (country, state or province, county, city)

11. Description of contract work (Describe the nature and scope of the work and provide an explanation of how the work is the same, or similar to, the work required by the solicitation). Attach an explanation of any performance problems or other conflicts with the customer. (Use a continuation sheet, if necessary.)

12. Customer Assessment (Address Quality, Schedule, Cost Control, Management, and Regulatory Compliance, as applicable, using ratings definitions under the instructions below. Provide supporting rationale for each rating provided ) (Use a continuation sheet, if necessary.) (Only complete this section if there is no supporting CPARS on record)

Quality:

Schedule:

Cost Control:

Management:

Regulatory Compliance:

13. Current status of contract (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, claims negotiations pending or underway ☐ Work completed, litigation pending or underway

☐ Terminated for convenience ☐ Terminated for default ☐ Other (explain)

Instructions for Completing the Experience/Reference Information Sheet

Item 9a. Insert the name, title, address, telephone no., and email address (if available) of the program or project manager or other customer technical representative who is most familiar with the quality of your work under the contract.

Item 9b. Insert the name, title, address, telephone no., 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 10. Insert the location(s) where the work was performed.

Item 11. 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 quotations. 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 to take to correct any shortcomings in your performance.

Item 12. List and provide supporting rationale for the ratings provided by the customer. Definitions are provided below. Only complete this section if there is no supporting CPARS on file.

Evaluation Ratings

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided for each question. The rating scale is defined as follows:

Item 13. Select the current status of the contract Item 14. Have a customer representative sign the evaluation, only if there is no supporting CPARS on file.