J._4_Past_Performance_Information_Form_Rev.1.pdf

SOLICITATION: EA-133M-17-RP-0081

ATTACHMENT: J.4

PAST PERFORMANCE INFORMATION FORM Form _____ of ______

CONTRACT NUMBER: AGENCY OR CLIENT:

1. Refer to Section L of Solicitation EA-133M-17-RP-0081, Instructions to Offerors, REQUIREMENTS FOR PROPOSAL CONTENT. The offeror shall complete this form in its entirety for each contract identified in the offeror’s Volume I – Past Performance Proposal.

2. Check one of the following statements:

CPARS - The referenced Contract Number has a completed CPAR and can be located in the Past Performance Information Retrieval System (PPIRS).

Past Performance Questionnaire (Fill-in Data under item 3 prior to sending to Agency/Client POC)

_______ The Point of Contact or Project Manager associated with the work completed under the referenced Contract Number has been sent this form and the Past Performance Questionnaire to complete and return to Contract Specialist, Sarah Rall prior to the closing date of the solicitation: July 21, 2017, 1:00 pm EST.

EMAIL: sarah.rall@noaa.gov

3. Provide the following data in its entirety.

a. Contract Number and Client point of contact (including 2 points of contact with telephone numbers)

POC #1: __________________/Phone: ___________________

POC #2: __________________/Phone: ___________________

b. Ship Name, Hull Number: ___________________________________

c. Dollar Value of the contract (Original: $ _______________and Final: $_________________)

d. Type of service performed and whether Prime or Sub Contractor: Type: _______, Prime or Sub: _________

e. Contract performance period at the start of the contract: Start: _____________ End: __________________

f. Actual performance dates upon completion: Begun: ______________ Completed: __________________

g. Contract Type: _______________

h. Percentage of growth in contract price (Additional work divided by award price) and the extent of Subcontracting:

Growth Percentage: __________% Extent of Subcontracting: ___________________________

NOTE: It is the responsibility of the Offeror to follow‐up and to encourage references to submit the questionnaire prior to the solicitation closing date of: July 21, 2017, 1:00 pm EST.

Rev.1