Attachment_5_-_PPIF.docx

FA0021-16-R-0040

Attachment 5 7 September 2016

PRESENT AND PAST PERFORMANCE INFORMATION FORM (PPIF)

Provide the information requested in this form for each on of the present or past contracts you have identified as recent and relevant for this solicitation. Provide a separate completed form for each contract identified. Attach a separate sheet if additional space is needed.

A. Current Offeror (Company/Division):

Cage Code:

DUNS Number:

Additional Information: (If Present/Past Peformance is for major subcontractor, please provide Company Name of subcontractor and annotate on this block as Subcontractor. If the company or division performing this present or past effort is different from the current Offeror, not this fact on space provided. Refer to the “Organizational Structure Change History” you provided as past of your Past Performance Volume.)

B. Program Title:

C. Contract Specifics

1. Customer Name:

2. Customer Address and Phone No.

3. Contract Number and all applicable Order Numbers (i.e. Task Order, Delivery, Order, etc.):

4. Type of Contract

5. Period of Performance

8. Reason for Change(s) in Value:

9. Original Completion Date:

10. Current Scheduled Completion Date:

11. Number and Reason for Change(s) in Schedule:

D. Description of Effort as Prime or Subcontractor

E. Describe how the work under this contract relates to this requirement. Please reference PWS paragraph reference when appropriate.

F. Self-assessment of past performance record. Provide information of any problems encountered and your corrective actions.

G. Current Status of Contract

H. Primary customer points of contact.

POINTS OF CONTACT

Name:

Office:

Address:

Phone:

E-Mail:

Other (specify)::

Name:

Office:

Address:

Phone:

E-Mail:

I. Include below relevant information concerning compliance with FAR 52.219-8, Utilization of Small Business Concerns, under the cited earlier contract.

J. Subcontracting Plan Requirements

1. Was subcontracting Plan required?

2. Planned goal %

3. Achieved goal%

4. Explain why any goals were not met.