Attachment 7 - PPQ Submission Form.pdf

ATTACHMENT #7

FA8051-23-R-0005

PAST PERFORMANCE INFORMATION

Provide the information requested in this form for each contract/program (citation) being described. Only

Past Performance with NAICS 541511 will be evaluated. Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted. Limit the number of citations submitted and the length of each submission to the limitations set forth at paragraphs (b) and (b)(10), respectively, in the solicitation.

A. Offeror Name (Company/Division): ____________________

UEI Code: ____________________

(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. Refer to the "Organizational Structure Change History" you provided as part of your Past Performance Volume).

B. Program Title: ____________________

C. Contract Specifics:

1. Contracting Agency or Customer _____________________________________________

2. Contract Number__________________________________________________________

3. Contract Type __________________________

4. Period of Performance __________________________

5. Original Contract $ Value _________________ (Do not include unexercised options)

6. Current Contract $ Value _________________ (Do not include unexercised options)

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 (or Service) 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. 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).

2. Contract Administrator:

Name ____________________

Email ____________________

Telephone__________________

3. Administrative Contracting Officer:

Name ____________________

Email ____________________

Telephone__________________

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

H. For each of the applicable sub-factors under the Technical factor listed in the Combined Synopsis/Solicitation, illustrate how your experience on this program applies to that sub-factor

I. Include relevant information concerning your compliance with FAR 52.219-8, Utilization of Small Business Concerns and 52.219-9 Small Business Subcontracting Plan, on the contract you are submitting.