Attch 4. F&ES PPE Ensemble PPI Submission Form.pdf

ATTACHMENT #4

PAST PERFORMANCE INFORMATION

FA8051-21-R-0001

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

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 paragraph 7.2 in Attachment 6, Instructions, Conditions, and Notices to Offerors of this solicitation.

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.

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).

1. Program Manager and/or Site Manager:

Name ____________________

Office ____________________

Address________________________________________

Telephone__________________

FAX Number_______________

2. Contracting Officer:

Name ____________________

Office ____________________

Address________________________________________

3. Administrative Contracting Officer:

Name ____________________

Office ____________________

Address________________________________________

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 in Attachment 7, Evaluations Factors for Award, 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, on the contract you are submitting.

J. 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).