Attachment 5 - Past Performance Information Form.docx

RFQ: FA8501-22-Q-0011

ATTACHMENT 5

PAST PERFORMANCE INFORMATION FORM

Washer and Dryer Lease Services

Provide the information requested in this form for each contract/program being described. Provide frank, concise comments regarding your performance on the contracts you identify.

A. Offeror Name (Company/Division): CAGE Code:

DUNS Number:

NOTE: If the company or division performing this effort is different than the Offeror or the relevance of this effort to the instant acquisition is impacted by any company/corporate organizational change, note those changes here:

B. Program Title:

C. Contract Specifics:

1. Contracting Agency or Customer:

2. Contract Number:

3. Contract Type:

(If multiple types (i.e. Firm-Fixed Price with Time & Material), list percentage and dollar amount of Firm-Fixed Price portion)

4. Period of Performance:

7. If Amounts for 5 and 6 above are different, provide a brief description of the reason:

D. Brief Description of Effort as Prime or Subcontractor (Please indicate whether it was development and/or production, or other acquisition phase and highlight portions considered most relevant to current acquisition)

E. Completion Date:

1. Original date:

2. Current Schedule:

3. Estimate at Completion:

4. How Many Times Changed:

5. Primary Causes of Change:

F. Are there Contractor Performance Assessment Reports (CPARS) or other Past Performance Reports available for this contract? YES NO

G. Primary Customer Points of Contact: (For Government contracts, provide current information on all three individuals. For commercial contracts, provide points of contact fulfilling these same roles).

1. Program Manager and/or Name: Site Manager Office:

Address:

Telephone: E-mail:

Telephone: E-mail:

3. Administrative Name: Contracting Officer Office:

Address:

Telephone: E-mail:

H. Address any technical (or other) area about this contract/program considered unique.

I. For each of the applicable subfactors under the technical approach factor that illustrates how your experience on this program applies to that subfactor, if you are to perform the same effort on the proposed contract.

J. Specify, by name, any key individual(s) who participated in this evaluated program and are to support the proposed effort. Also, indicate their contractual roles for both acquisitions.

K. Describe the nature or portion of the work on the proposed effort to be performed by the business entity being reported here. Also estimate the percentage of the total proposed effort to be performed by this entity, and whether this entity will be performing as the prime, subcontractor or a corporate division related to the prime (define relationship).