ATTACHMENT 6 PAST PERFORMANCE QUESTIONAIRE.pdf

DRAFT

Solicitation Name

Solicitation No.: TBD Section X.X-X Page 1

Past Performance - Contract/Task Order Template

GENERAL INSTRUCTIONS:

1. Reference Sections L.2.

2. Offerors shall respond to all questions and requests.

3. This form should be completed by the offeror.

4. Offerors should complete a separate template for each of the three (3) contracts to be submitted.

5. All proposal documentation associated with this template shall be scanned documents in PDF format.

7. All file attachments shall be included in Volume 3 of the Offeror's proposal submission in accordance with the Proposal Format Table in

Section L.2.

8. Offeror should submit a copy of this completed template to their listed Customer contact with the Past Performance Questionnaire.

PART I: Contract Identification

TASK ORDER UNDER A MASTER

IDIQ TASK ORDER CONTRACT

(FAR 16.5)

TASK ORDER UNDER A

BLANKET PURCHASE

AGREEMENT (FAR 8.4)

DRAFT

Contract Type:

Firm Fixed Price

T&M

Cost Reimbursement

Hybrid*

Contractor Information:

Contractor (Firm) Name:

CAGE Code:

Address:

Point of Contact (POC):

POC Phone Number: POC

E-mail Address:

Contract Information:

DUNs Number:

Contract Number:

Task Order Number

(If applicable):

Work Performed as:

Percent of contract work performed:

Prime Contractor

Sub Contractor*

Joint Venture*

*If Sub Contractor or Joint Venture, who was the prime (Name/ Phone #):

What is the type of vehicle?

(Check only one):

CONTRACT (not a Task Order)

Solicitation No.: TBD

Section X.X-X

*If Hybrid, specify percent (%) of work under each contract type :

Contract Title:

Contract Location:

Award Date (MM/YYYY):

Total Period of Performance (Does not include unexercised options):

MM/YYYY - MM/YYYY

Ultimate Completion Date (MM/YYYY):

What is the number of FTE* by year on this contract?

*Full Time Equivalent (FTE) is defined as working on this contract greater than or equal to 1500 hours annually.

Award Contract Price:

If a services contract provide 1) Annual and

2) Cumulative totals per

POP:

What is the current status of the contract?

Contract was completed within the past Five (5) years of the issuance of the ITO or the contract is ongoing, with at least Twelve (12) months of continuous performance prior to the issuance of the ITO None of the above

PART II: Contract Reference Information

Customer Name:

Funding Agency ID (If applicable):

Contracting Officer (or Corporate Official for Commercial Experience):

Solicitation No.: TBD Section X.X-X

Name:

Title:

Phone Number:

E-mail Address:

Program Office Contact:: (Senior Program Official or Corporate Official for Commercial Experience):

Name:

Title:

Contracting Officer's Representative: (or Corporate Official for Commercial Experience):

Name:

Title:

Solicitation No.: TBD Section X.X-X

Part III: Contract Description

1. Contract Description: (no page limit; offeror shall use attachment XX for additional pages)

Solicitation No.: TBD Section X.X-X

2. Complexity of Work: High Medium Routine

Briefly describe the complexity of work (Please provide details such as similar equipment, requirements, conditions, etc.).

Does the contract involve subcontracting or teaming?

Yes*

No

*If Yes, provide the number of subcontractors or teaming partners involved:

Solicitation No.: TBD Section X.X-X

3. Small Business Utilization Description: (no page limit; offeror shall use attachment XX for additional pages)

Solicitation No.: TBD Section X.X-X

PART IV: Contract Verification Method

Signature below by a Contracting Officer, Contracting Officer's Representative, or Corporate Official for the ordering activity constitutes acceptance of the above contract information to be accurate as ordered and received by the listed entity.

Name:

Date:

Signature: